Service Excellence
_______brought sweeping changes to how health insurance is accessed in the US.
What is the ACA?
What’s the fastest way to submit documentation?
Upload!
QHP
Qualified Health Plan
Making a changes to an application is called?
Reporting a Change
If a Navigator is calling in without the member, how should the Tier 1 Agent proceed?
Confirm the NAV has an NDF (Navigator Designation Form) on file, then proceed with the call.
True/False: The Health Connector offers Unsubsidized or full cost health plans?
True
What does RFI stand for?
Request for Information
DPV
Document Process Verification
True/False: A member can add a Social Security Number but cannot make an update to their SSN.
True, they need to call the Call Center in order to update an SSN.
True or False: If a CAC calls in, and the member has MassHealth eligibility, the Tier 1 Agent can assist if the member is on the phone.
False- If the CAC calls, and the member has MassHealth, the Tier 1 Agent should refer to the MassHealth Assister Line.
Applicants must meet what requirements to apply for coverage?
Must be a U.S. Citizen, U.S. National, or an immigrant that is lawfully present in the United States
Must not be in jail or prison
Must intend to reside in Massachusetts
Name 2 out of the 5 Qualified Life Events for SEP Verification.
Marriage, Adding a dependent (birth or adoption), Adding a dependent (birth or adoption), Loss of minimum essential coverage (MEC) , Or change in residency
APTC
Advance Premium Tax Credit
True/False: Once a change has been made, HIX automatically runs the eligibility.
False, an agent needs to resubmit their eligibility application in order to see their most updated eligibility.
True or False: If a NAV calls in and needs to unlock IDP, the Tier 1 Agent can do this while the NAV is on the phone.
True – The Tier 1 Agent will unlock while the NAV is on the phone and they will send in documents within 48 hours.
What is a QHP?
Qualified Health Plan
If a Health Connector member’s information cannot be verified, are they able to complete their enrollment?
YES, they can complete their enrollment. They will have 90 days to send in any documents to satisfy any eligibility Request for Information (RFI).
NAVDF/CACDF
Navigator Designation Form/Certified Application Counselor Designation form
When adding a dependent to an application during closed enrollment, how long does the member have to report this change?
60 DAYS
If a NAV or CAC calls and they are not certified with the state, can the Tier 1 Agent can continue with the call.
No- the Tier 1 Agent must refer the NAV or CAC to their lead, who can reach out to their Health Connector or MassHealth contact to grant them access
What does MEC for and what does it include?
The Minimum Essential Coverage includes these 10 EHB (Essential Health Benefits) :
Outpatient care
Emergency Room Services
Hospitalization
Mental and behavioral health treatment
Prescription drugs
Maternity and newborn care
Services and devices to help people with injuries, disabilities, or chronic conditions
Lab tests
Preventive and wellness visits, including chronic disease management
Pediatric care
What does RFI status code Active mean?
Member is required to send in RFI documentation listed within 90-days from request.
RFI
Request for Information
List three types of changes to a member's account that a Tier 1 Agent can make in HIX.
1. Demographic changes (physical address, mailing address, phone number, language preference, email address)
2. Change of Income: (subsidized applicants only)
3. Application type or enroll in a new health or dental plan
4. Add or remove a family member
5. Cancel a Member’s health or dental coverage
6. Name Change
The Navigator needs an NDF form to assist the consumer. What does NDF stand for?
Navigator Designation Form