Authorization and Disclosure
To pass disclosure, the consumer must provide 3 pieces of information, including their first and last names and any 2 of the following:
Date of birth, Address, Social Security Number, and Application ID.
11:59 p.m., eastern time, on the last day of their eligibility window.
A copy of the previous year’s Form 1095-A is mailed out when?
By mid-February each year.
What Is a DMI?
When you submit your application, we check the information you provide against records from sources like Social Security and the Internal Revenue Service. If the information doesn’t match, it causes a data matching issue.
_________ typically pay for all fees associated with your care except for agreed upon out-of-pocket costs.
Health maintenance organization plans, also known as HMO plans
When the consumer has passed disclosure and is on the phone with another person, what 2 authorizations can be provided?
Verbal permission and Verbal authorization
What do you do when an employer coverage changes?
Update application; may adjust the premium tax credit and/or cost-sharing reduction amount. Refer to the "Tax Credits and Premium Confirmation" section.
What Happens if a DMI Isn’t Resolved?
You may lose coverage if your issue isn’t resolved before the deadline; You may lose some or all of your tax credits or cost-sharing reductions if your issue isn’t resolved before the deadline.
___________
- Require you to designate an in-network physician to be your primary care physician.
-Allow you to use any health care provider, either in-network or out-of-network. A network is a specific group of doctors, hospitals, and other health care providers that provides medical care for its network members.
Point-of-Service (POS) Plans
If Consumer Is Not on the Phone and the caller is not authorized, what should you do first?
Check to see if the consumer is available to provide verbal permission for you to speak with the caller.
If the application update changes the consumer’s monthly premium or the premium tax credit amount, you must confirm what information?
Depending on the type of coverage the consumer had, what types of forms could the consumer receive?
Form 1095-B or a Form 1095-C
What are the 2 ways to submit documents?
- don’t usually require referrals to see specialists.
- Contact your insurance company for more information about providers and referrals. If staying with your current doctors is important to you, make sure that they’re included in the provider directory before enrolling. Contact the plan or provider to be sure.
Point-of-Service (POS) Plans
When Reporting Incarceration to the Marketplace what should you do if the caller is NOT age 18 or older and is NOT:
Refer to the "Escalate to the Advanced Resolution Center" section.
If you change plans or update who’s getting coverage, your _________ and anything you’ve paid toward your annual out-of-pocket limit _____________.
deductible; may reset.
What script should you refer to if the consumer didn’t get a Form 1095-A and the form isn’t in their HealthCare.gov account
Form 1095-A HICS Escalations
What is the address to mail documents?
Health Insurance Marketplace
Attn: Coverage Processing
465 Industrial Blvd.
London, KY 40750-0001
- Don’t usually require referrals to see specialists.
- Contact your insurance company for more information about providers and referrals. If staying with your current doctors is important to you, make sure that they’re included in the provider directory before enrolling. Contact the plan or provider to be sure.
Exclusive Provider Organization (EPO) Plans
What actions do you take to remove an authorization?
When Moving to a different US state or moving from outside the United States may require a new application. What script should you refer to for more information.
Moving Back to the United States or to Another State
if you get an error message, try refreshing the page and selecting the ______________, If the issue continues, use the READ below and submit the following feedback in the _____________ category in NGD.
CSR Reprint button one more time. ;HealthCare.gov System Error
What can be used to provide proof of Veterans Affairs (VA) Coverage Status
_______________
-Provide coverage for certain types of unexpected, expensive services like hospitalization, illness, or serious injury.
-Cover 3 primary care visits per year and certain preventive services at no cost.
Catastrophic Health Insurance Plans