Plan Designs
How much would be the cost for NEDD plan for my son who is 20 years old enrolling by himself?
$50
Customer calling to report income change effective next year, How should you report this change?
Enter 1/1/2025 as the start date and put an end date of 12/31/2024 for the same income changing in the following year.
When is the Annual Open Enrollment Period?
11/1/-1/15
How does Cost Sharing Reduction work?
Customer must select a silver plan and be income eligible for one of the CSR levels (I-IV). CSR reduces the out of pocket costs, such as Deductible and copayments.
Timesheet: When do you need to enter your hours in Costpoint?
Daily at the end of each shift.
What is my individual medical deductible for BCBSVT Silver 94 Plan?
$250
If there was a change to a household member's name, date of birth, SSN, gender, or address, after processing renewal what is your next step?
Be sure to make these same changes in ACCESS if they are active in access.
Do customers need SEP to change their plan?
Not during open enrollment period
My daughter is turning 26 in November, will she need to enroll in her own plan for December?
no,
A 26 year old will remain on their family plan until the end of the year of their 26th birthday.
When verifying the customers mailing address and customer forgets to provide part of the address (zip code, unit/apt#, ect) Have you fully verified the address?
no, you must ask the customer to provide the full address.
What is a integrated deductible plan?
A type of deductible where both prescription drugs and medical expenses contribute towards the deductible. If the deductible is not integrated, only medical claims accumulate to the medical deductible and prescription drug claims accumulate to the prescription drug deductible.
When should you update the Medicaid Next Renewal date before processing QHP Renewal?
If the Medicaid NRD is less than the QHP NRD
-Don't forget to update it back after QHP renewal has been completed.
When customer calls in on 12/20/2024 and selects a plan what would their coverage start date be effective?
2/1/2024 during AOEP unless they have an SEP.
I have enough subsidies to cover the full cost of the BCBSVT plan, why is my final cost .20 cents?
Currently, Blue Cross is the only carrier that offers additional benefits in all their plans. Therefore, Blue Cross plans should NOT have a $0.00 final cost.
If agent started work at 8AM and took 33min lunch and left work at 4:33PM, what would their hours be?
8
What is a aggregate deductible?
All individuals in a family contribute to one family deductible. Once this deductible is met, cost-sharing (co-pays and co-insurance) goes into effect for all family members.
If the Health Insurance Case Next Renewal date is 11/1/2024 what is your correct step before processing QHP renewal?
Update the QHP NRD to 1/1/2025.
Do I need to do anything if I want to keep the same plan for next year?
No, as long as you have given auto renewal permission your plan will continue effective 1/1/2024.
(CSR would need to check CRM to make sure we have Zero Auth permission)
If I change my plan from MVP to BCBSVT will the amount for the deductible that I already met carry over?
Customers who change plans mid-year and remain with the same carrier will have amounts applied towards their deductibles and OOPM carried over to their new plan. If the plan change is to another carrier, the amounts will not be carried over. Customers should contact the carriers directly for more information.
In the event if the customer doesn't pick up during a curtesy call back request, where do you document your Service request and what aux should you be using?
General info Contact ID: 1-23XZ3DR
Busy>special project
2 part question 1. Does BCBSVT Platinum Plan have an aggregate or stacked deductible? 2. What does it mean?
1. Stacked deductible
2. The individual deductible still exists, giving family members a second way to meet their deductible. If the individual deductible is met before the family deductible, cost-sharing goes into effect for that individual family member.
If the benefit plans for the health insurance case shows status as approved, do you still proceed with QHP renewal?
No,
The renewal has been completed and nothing further is needed
Refer to Plan Designs and Rates to answer any questions the customer has
I have a change in income effective 1/1/2025 when should I report this change?
Changes need to be reported by December 15th in order to be effective 1/1/2025. Changes reported after December 15th will result in a 2/1/2025 effective date.
What is the different between Standard Plans and Non-Standard Plans?
All plans cover the same essential health benefits, but non-standard plans may include additional coverage or specialized wellness programs.
Customer showing active in CRM and in Access, however coverage not showing in Gainwell, what is the process to take?
Billing issues for system discrepancy> Escalate ATC if there is ATC need