ELIGIBILITY AND ENROLLMENT
Immigrants outside the U.S. seeking safety here are called?
Refugees
When might you ask for one-time verbal authorization?
When a non-HOH cannot be verified
Which dental plan offers Pediatric Coverage?
All Health Connector dental plans
What workflow helps walk a member through setting up autopay?
Billing and Payments
What must CSRs do after greeting a caller?
Ask for HOH first name, last name, DOB, last 4 of SSN
What age allows dependents to stay on their parents' plan under ACA?
Under 26
True or False: Legal Skinnies must be read verbatim if not played by recording?
True
Can members get subsidies based on household income?
true -yes
What system do CSRs use to authenticate HOH info?
HIX
True or False: CSRs can discuss the account but not make changes if the caller is non-HOH with ARD?
False
What triggers a Special Enrollment Period?
Qualifying Life Event
Which system helps locate unprocessed Contact Forms?
myWorkspace
What dental services are considered major care?
Crowns, Dentures
Who can cancel a dental plan?
HOH, adult dependents, authorized representatives
How long does a member have to report a change to add a dependent during closed enrollment?
60 days
Can a member shop for plans themselves if they know their options?
True
What type of documentation proves a member’s immigration status?
Permanent Resident Card
Name two dental carriers available through Health Connector?
Altus Dental, Delta Dental
Can CSRs set up autopay for members?
No
What happens if eligibility details don’t match Federal HUB?
Timeclock starts
What is required for health insurance if enrollment is closed?
SEP/QLE
What must be verified before issuing a refund?
Credit, refund matches request, no existing refund case
Does Delta Dental Comprehensive coverage include Orthodontia?
False-No
Which system allows members to add a dental plan?
Member Portal
Can a member appeal a denied coverage determination?
Yes