ACA Law
What day did the Affordable Care Act begin?
March 23, 2010
Why is it important to enter timekeeping daily?
Because it's a GLSP requirement under our contract; and it ensures we get paid properly
Clients income is $15,090; HH of 2, child is 12. Client works 30 hours a week.
Child is eligible for Medicaid; parent is eligible for Georgia Pathways.
What is our application goal? and from what time period?
40 each; September to August
Consent forms are emailed to our GE email box. What's the process?
Aeriana will review, upload, and call them for an appointment.
What are the two laws that make up the Affordable Care Act?
Patient Protection and Affordable Care Act
When is timekeeping due (day & time)? What are the exceptions
Every other Friday by 10AM. Exceptions are days off then it's due on your last day before Friday by noon.
Client's is a caregiver to her father making $420 a week. She has a 9 year old. She doesn't have any other income.
How do we "name" Immigrants who are eligible for the Marketplace?
Lawfully Present Aliens
DACA residents are eligible for what type of plan and when?
The Marketplace beginning September 2024.
Describe "no lifetime or annual limits"?
a group health plan, or a health insurance issuer offering group or individual health insurance coverage, may not establish any lifetime limit on the dollar amount of essential health benefits for any individual, whether provided in-network or out-of-network.
When speaking to a client from the call center how do I report it on my timekeeping?
ACA2024 Call Center (do not create a new one...use the one that's existing)
The Marketplace
What is Georgia Access?
Georgia Access is the state's program for Georgians to shop for and enroll in health insurance. With Georgia Access, Georgians will find many options to enroll in high-quality, comprehensive, and affordable health insurance
How many days can you appeal a plan on the Marketplace? How many for Medicaid?
90 days and 30 days; unless it's Medicaid Unwinding. Then it's 90/90.
There are several things that the ACA prohibits. Name two.
45 CFR § 147.108 - Prohibition of preexisting condition
45 CFR § 147.110 - Prohibiting discrimination against participants, beneficiaries, and individuals based on a health factor
45 CFR § 147.116 - Prohibition on waiting periods that exceed 90 days.
If I answer an email from a client what should I do?
Forward the email to OM "NOTES"; add time as case-related-letter writing.
Student moved from Alabama to Georgia to go to Emory. He needs healthcare. What questions should you ask him?
Can he sign your consent form?
Parents income;
Will they claim him in 2025;
Will Georgia be his State of residency?
Can he provide a copy of enrollment?
Georgia Pathways if income meets eligibility and he's not a resident of Alabama; then the Marketplace
What is a complex case?
A Complex Case is a case involving a single consumer or tax household where the assister has been unable to resolve a specific issue on the consumer or tax household’s application for Marketplace coverage. Complex cases are not policy questions or general questions about the Marketplace application.
What is KnowBe4 and why is it important? What is due by when for ALL Navigators?
KnowBe4 is a required LSC training to maintain our LSC grant. It's due by 9/30/24, but it's best to do it when emailed. Emails come from Susan (she's watching). Licensing training is required and due by August for ALL Navigators.
Name an exception to guaranteed renewability of coverage?
(b) Exceptions. An issuer may nonrenew or discontinue health insurance coverage offered in the group or individual market based only on one or more of the following:
(1) Nonpayment of premiums. The plan sponsor or individual, as applicable, has failed to pay premiums or contributions in accordance with the terms of the health insurance coverage, including any timeliness requirements.
(2) Fraud. The plan sponsor or individual, as applicable, has performed an act or practice that constitutes fraud or made an intentional misrepresentation of material fact in connection with the coverage.
(3) Violation of participation or contribution rules. In the case of group health insurance coverage, the plan sponsor has failed to comply with a material plan provision relating to employer contribution or group participation rules, pursuant to applicable state law. For purposes of this paragraph the following apply:
How should events be categorized in "Other Matters"? What should be included? And who creates the event. How should it be entered in timekeeping?
Once approved, Rebecca creates OM events and forwards the link. Events should be categorized under the sponsor. The title, including the flyer and contacts, should be separate and placed under the event name. It's important to include timekeeping (Community Education or Networking or Coordination), the number of attendees, interactions, appointments, and applications in the event for a complete overview.
52 years old with significant medical needs; lost Medicaid on 3/5/24. Has 20 year old. Prescriptions and other expenses run $13,000 a month. Lives with mother and stepfather who are supporting her. She has no income. Mother and stepfather have income of approximately $5800 a month and claim Lydia as a dependent. They are around 80 years old.
Verify that her medical needs isn't on the compassionate allowance list, or HICP (Health Insurance Continuation Program). If not, she's not eligible for anything. We can only help with savings on meds with needy meds.
Name three reasons someone should/can submit an appeal?
The Marketplace said I'm not eligible to buy a Marketplace plan.
The Marketplace said I'm not eligible for financial help with Marketplace costs (including premium tax credits or cost-sharing reductions).
I disagree with the amount of financial help the Marketplace said I qualify for.
The Marketplace said I'm not eligible for a Special Enrollment Period to enroll in or change my Marketplace plan.
The Marketplace said I'm not eligible for a Catastrophic plan.
The Marketplace said I'm not eligible for an exemption from the requirement to have health insurance.
Other
Is there any option for this client to get any coverage through the marketplace with no income? We are giving her information on cancer state aid but she would not be eligible for Medicaid. She's not working or doing any training activities that would qualify her for Pathways.
Compassionate Allowance
Marketplace if she becomes someone's dependant
Marketplace if she plans to go back to work?