FFM
Scenario: You receive a call from Amanda Sykes, who needs help logging in to her fathers 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 daughter.
Scenario: You receive a call from Mike Lowery, open a call record, and confirm his full name.
What else do you need from Mr. Lowery to complete disclosure?
His date of birth and address
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).
Scenario: King Maverick is calling because he received an insufficient notice about documents, he submitted to prove his daughter Madison’s income and he doesn’t understand why. Mr. Maverick is worried about getting his additional documents to the Marketplace in time.
What can you do to help him?
Offer to guide him as he logs in to his HealthCare.gov account and uploads the documentation.
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: Amira Wilson calls and says, “I’m really confused. I signed up for a Marketplace plan, and it said that my family deductible was only $10,000, but when I got my paperwork, it says the deductible is $20,000. What do I do?”
You pull up the Plan Issues script. What row of the table in the “Issues with Billing or Plan Costs” section should you use to help Ms. Wilson?
Cost-Sharing Discrepancies
Mr. Lewis says that his wife’s Medicare coverage starts on September 1 but that he needs to keep his coverage because he does not yet qualify for Medicare.
What should your next step be?
Update the application with Mrs. Lewis’s Medicare start date.
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 King(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?
Complete an application reporting the loss of employer coverage
Scenario: You receive a call from Anthony Harris. He has a question about his Form 1095-A.
According to the call flow, what should you do next?
Open the call record
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.
Scenario: You receive a call from Avil King. She completed her application and enrolled in a plan but is upset because she has a citizenship data matching issue (DMI) even though she is a US citizen. She doesn’t understand why she has to submit documentation when she provided so much information on her application.
How can you help Ms. King resolve her DMI?
Offer to go through her application with her and see if she accidentally entered any incorrect data.
You receive a call from Emily Lucero. She recently received a notice asking her to submit additional documents to prove her citizenship. Ms. Lucero is very concerned and wants to know what will happen if she can’t send the documents in time.
What could happen if Ms. Lucero doesn’t send in her citizenship documents before the DMI expiration date?
She will lose her Marketplace coverage.
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.
Scenario: You receive a call after the open enrollment period from George Lopez. He lost his job, and he and his wife no longer have coverage through his previous employer. They had coverage a few years ago from the Marketplace, and Mr. Lopez wants to know if he and his wife are eligible for Marketplace coverage again.
What is your next step to help Mr. Lopez?
Create a new application to see if the consumers are eligible for a special enrollment period.
Where can the consumer find information on their own about what they should submit to prove citizenship?
In their eligibility determination notice
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 Meza calls on March 1 because she never received a Form 1095-A in the mail. You use the Documents view to confirm that she does have an active Form 1095-A. You open it and check the address on the cover letter to make sure it matches the consumer’s current mailing address, but it does not match.
What is the best question to ask this consumer?
Have you recently moved?
Scenario: You receive a call from Kevin Martin. He is calling because he received an insufficient notice about documents he submitted to prove his daughter Madison’s income and he doesn’t understand why.
What should you do first to start helping Mr. Martin?
Go to the Documents view and review the notice sent by the Marketplace.
How long does the consumer have to resolve their special enrollment period verification issue after selecting a plan?
30 days
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