Intro to Health Connector
How many health plan carriers do we have and name them?
8 carriers:
United Healthcare, Blue Cross Blue Sheild Massachusetts, Fallon health, Mass General Brigham, Wellsense, Tufts, Harvard Pilgrim, Health new england
What systems are used for authentication? Name 3
Salesforce, HIX and MyWorkspace
A __________ is the payment that must be made every month (regardless if benefits are used) in order to maintain active coverage with the Health Connector.
Premium payment
What do you do if entire household is cancelling coverage?
Cancel the entire household’s coverage in HIX.
The best Guided Workflow to use for this category?
Reinstatement
How many dental carriers does Health connector have and name them?
2 carriers: Altus dental, Delta Dental
What is a good clue that you’re not speaking with the HOH
When they’re an existing member, but their name doesn’t come up under the Individual search.
The term_________ is used to describe the very first premium payment a member must make in order to effectuate a new plan.
Binder payment
Steps if HOH is deceased
•Contact escalations and get an admin closure.
•The remaining members will then need to apply in a new HIX application and request a retro enrollment.
When a member makes a request to cancel their coverage. What is it called?
Voluntary Termination
Three requirements every applicant must meet to be eligible for any type of coverage through Health Connector
#1 Must reside or intend to reside in the state of Massachusetts
#2 Must be a U.S. Citizen, U.S. National, or an immigrant lawfully present in the U.S.
#3 Must Not be incarcerated in jail or prison
List the information that must be requested from the HOH in the exact order it must be requested in?
First name
Last name
Date of birth
Last 4 digits of the SSN
Premium payments and binder payments are both due on ______?_______
23rd of the month
Dependents who are part of the household, who turn _________ old are considered aged out.
26 years
When a member’s coverage was cancelled automatically. What is it called?
Involuntary Termination
Step 2 in the Eligibility Process
Applicants must meet the following requirements to receive financial help
1)Must be within the required household income levels to receive subsidies
2)Must NOT qualify for other affordable Minimum Essential Coverage (MEC) including MassHealth, Medicare, Veterans Affairs benefits or employer-sponsored insurance
3)Must agree to file taxes and if married, file their taxes jointly
Authentication information should always be verified in ____ because it is considered the source of truth for member data.
HIX
Members have ____?___opportunities to make their binder payment to avoid their enrollment being canceled for non-payment
2
5 Reasons why a member would want to cancel their coverage:
1.Member has other healthcare coverage
2.Member had a negative experience with the Health Connector
3.Household member no longer part of the household
4.Premiums/co-pays are too expensive
5.Member is moving out of state
Tier 1 agents can only assist in reinstating members who have been terminated for __________.
non-payment of premium
How to use your APTC:
3 APTC options
The HOH’s name will always be listed first in the ______ ______ section of the Account Dashboard in HIX.
Latest Eligibility
What happens if a member makes partial binder payments both months
Member is non-payment canceled
NPP cancel notice is sent
Disenrollments, cancellations, and terminations are all considered__________
Same
Reinstatement requests that are outside of the ______ window must be routed to Tier 2
35 days