FFM
Scenario: You receive a call from Amanda Sykes, who needs help logging in to her husband’s HealthCare.gov account. Mrs.Sykes confirms that she is not an applicant and is not the application filer. You check to see if she is an authorized individual on Mr.Sykes account, and you notice that the authorization has expired.
How should you get her reauthorized on Mr.Sykes account?
Ask to speak to Mr. Sykes so that he can complete the disclosure process and see if he would like to add an authorization for his wife.
Which fields should you use to begin searching for consumer information in Next Generation Desktop?
Last Name, First Name, and Date of Birth
Scenario: You hear the headset whisper “Marketplace,” but the call is from a Spanish-speaking consumer, and you do not speak Spanish. How do you proceed in helping this consumer?
You transfer the call to a Spanish-speaking customer service representative (CSR).
Where should you go in Next Generation Desktop to see the status of all household data matching issues associated with the application?
The DMI Status field on the FFM Individual Application Detail screen DMI view
Scenario: You receive a call from a consumer who speaks Russian and isn't fluent in English. He is able to provide you with his basic information to pass disclosure. However, you are not able to communicate with him any further. How do you proceed in helping this consumer?
You follow the process of connecting to the language line for translation assistance and proceed with the call.
Scenario: Samuel Briller calls and says, I just got a letter from my plan telling me that the plan I chose doesn't cover certain services, but I have the option to enroll in a different plan. Can you help me with this?”
Where can you view a sample copy of the letter the consumer received about the plan?
The Plan-Specific Letters reference material
Scenario: Ciara Borders calls the Marketplace because she has a problem with her Form 1095-A. The Social Security number (SSN) on it is not hers, and she’s concerned that she won’t be able to reconcile her taxes correctly.
What should you do to help her?
Tell Mrs.Borders that she can correct her SSN on her Form 8962.
After searching unsuccessfully with the consumers last name, first name, and date of birth, what should you do next to determine if there is an existing record?
Ask for the application ID and state.
Scenario: You receive a call from Trina Lee. She is applying for coverage for herself and her family. She lives with her husband and 2 kids who are attending college: Tre, 21, who is still claimed as a dependent, and Izzy, 27, who is not claimed as a dependent and files his taxes separately. Who can Mrs. Lee include on her application as members of her household?
Herself, her husband, and her younger child
Why would a consumer receive more than one 1095-A form with only some months filled on each?
The consumer had more than one plan for the coverage year
Julia Smith (has marketplace plan) calls on August 13 because her husband lost his employer coverage on July 31. She wants to know what he needs to do now to get health coverage. What should you do next to help the Smiths?
Update the application, reporting the loss of employer coverage to see if he qualifies for a SEP
It's April 11th a caller states they lost their job and no longer has coverage through their previous employer. What is your next step to help them?
Create a new application to see if the consumer(s) are eligible for a special enrollment period.
Scenario: Daniel Lewis calls the Marketplace because his wife, Kristi Lewis, is retiring and will be eligible for Medicare soon. They both have Marketplace coverage. What should you do to help Mr. Lewis?
Ask probing questions to determine when Mrs. Lewis’s Medicare coverage starts.
After reviewing the data matching issue notice on the Documents view, you notice that the consumers Social Security number (SSN) is incorrect. What can you do to help the consumer resolve this issue efficiently?
Update the consumer’s application with her correct SSN.
What should you do to help the consumer narrow the results from the Plan Compare tool to include only the plans that meet their needs?
Apply filters to the results from the Plan Compare tool
What should you do when you see attestation language while completing the application?
Read each attestation word for word and check with the consumer to make sure that they understand and agrees before continuing.
Where do you go to view the notice(s), consumers received?
The Documents view on the FFM Contacts screen
How do you know when the time to resolve a DMI will lapse/expire?
The Clock End Date field under the DMI View on the FFM Contacts Screen
After you help the consumer enroll and review health plan choices, what should you do next?
Ask if they would like to enroll in a separate dental plan.
Scenario: Sasha Fierce calls on March 1 because she never received a Form 1095-A in the mail. After finding her Form 1095-A on the Documents view, you ask her if she still lives at the address listed on the form. She says that she has recently moved and forgot to update her address with the Marketplace. What should you do to help this consumer?
Submit a Health Insurance Casework System (HICS) escalation for a Form 1095-A address correction and help her update her application with the new address.
Scenario: You receive a call from Lucy Lu. She recently received a notice asking her to submit additional documents to prove her citizenship. She is upset because she is a US citizen and doesn’t know why she received this letter. Besides the DMI view, where else can you look in Next Generation Desktop to begin researching Ms.Lu's issue?
Documents view
How long does the consumer have to resolve their special enrollment period verification issue?
30 days from selecting a plan
How would you explain easy pricing to the consumer?
This feature shows the consumer other options in their budget with the same out-of pocket costs that are still within the same plan category.
Scenario: Samuel Briller calls and says, I just got a letter from my plan telling me that the plan I chose doesn't cover certain services, but I have the option to enroll in a different plan. Can you help me with this?”
After checking consumer messages and not finding any related messages, you open the Plan Issues script. According to this script, how can you help this consumer?
Follow guidance for their plan in the Plan-Specific Issues (Letter Received) script.
Which tool should you use to help you correctly enter fluctuating income?
Monthly Estimator tool