Manual Account Creation and SEP pre-verifications

March 7, 2018

The webinar will begin at 12:30. If you can see this screen and hear the music you are prepared to participate.

The webinar is not being recorded, but this PowerPoint will be available on the Navigator/CAC Resource webpage.

SEP Pre-Verification Process

New SEP Pre-Verification Process

As of March 1, 2018, MNsure requires pre-enrollment verification for certain special enrollment period (SEP) enrollments for plan year 2018.

Pre-enrollment verification requires MNsure to hold certain SEP enrollments until the applicant/ enrollee provides documentation proving their qualifying SEP event.

MNsure will wait to send the enrollment to the health insurance company until after the consumer has submitted the verifications, and MNsure has verified that the documents meet the requirements for the SEP.

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SEP Pre-Verification Process

There are no new verifications requirements as a result of this process. MNsure will require pre-enrollment verification for only those SEP events where MNsure already requires proof.

Pre-enrollment verification will apply for both new and existing enrollees.

In addition to any verbal confirmations that enrollees will get from the Contact Center, enrollees will also receive a written request for proof and a written notice of the final enrollment determination based on if verification was provided or not provided.

SEP notices are manually generated and will not appear in the notifications area of the consumer’s account.

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SEP Pre-Verification Process

SEP events where MNsure requires proofs: Loss of minimum essential coverage (MEC) – other than

Medical Assistance and MinnesotaCare Gain of access to new QHP due to permanent move Marriage Birth, adoption, or placement for adoption or foster care,

or through court order Loss of dependent due to death or divorce Gain of citizenship/lawful present status Release from incarceration

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SEP Pre-Verification Process

1. If required, a SEP verification request is triggered upon determination of SEP eligibility.

2. Consumer will call the Contact Center to determine eligibility for the SEP, at which time the Contact Center will inform the consumer whether or not verifications are required.

3. Enrollees will have 30 days from date verification request is triggered to resolve the verification request. Upon request for verification, proof must be submitted within 30 days or the enrollment will expire.

4. Enrollees will receive both a written request for proof and a written notice of the final enrollment determination based on if verification was provided/sufficient or not provided/not sufficient.

5. The enrollment will be processed and sent to health insurance company upon receipt of acceptable verification documents.

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SEP Pre-Verification Process

When an enrollee is required to pay two or more months of retroactive premiums in order to effectuate coverage, the enrollee must be given the option to start coverage based on the original effective date or move the start ahead no more than one month.

If the consumer is eligible for this option, they have 14 days to call MNsure to change their plan’s effective date.

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SEP Pre-Verification Process: Scenario

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Submitting Pre-Verification Documents

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Consumers must submit a copy of at least one of the documents listed on the notice

The first and last name and case number (from the notice) should be written on all documents submitted

Documents can be submitted to MNsure in the following ways: Fax documentation (along with the first page of the notice)

to 651-431-7770 Mail documentation (along with the first page of the notice)

using the enclosed return envelope Upload documentation at www.mnsure.org/verify-qhp.jsp

Supporting Documentation Upload Tool

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Supporting documentation upload tool allows consumers to upload verification documentation requested by MNsure.

Consumers can access the tool with the link from their notice, or they can search on MNsure.org using the keyword “verify” or “upload”. They should select the search result titled “Upload Supporting Documents”.

Supporting Documentation Upload Tool

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To begin using the upload tool, the consumer will need: the case number printed under the date of the SEP notice The first name of primary applicant (person the notice was

addressed to) Last name of the primary applicant (person the notice was

addressed to)

Supporting Documentation Upload Tool

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To complete the upload tool, the consumer will need:• First and last name and DOB of primary applicant• First and last name and DOB for any individuals that supporting

documents are for• An email address (optional)• The first page of their SEP notice (optional, but preferred)

Supporting Documentation Upload Tool

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Supporting Documentation Upload Tool

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The tool can be used to submit documents to: Verify eligibility for a special enrollment period (SEP) Verify eligibility information on an application that cannot be verified

through electronic resources Technical requirements:

• A consumer can take a picture of the documents, or scan their documents to a PDF, in order to be able to upload them

• Documents can be submitted using a computer or mobile device• Documents can be a JPEG, GIF, PNG or PDF file type

• PDF files can contain multiple pages• JPEG, PNG or GIF file types contain one page

• Files cannot exceed 25MB in size• Consumers can include up to three separate files for each supporting

document submitted• All documents must be labeled with the first name, last name and case

number of the individual that the supporting documentation is for

Supporting Documentation Upload Tool: Tips for Assisters

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The tools cannot be used for verifications for cases that are public program only. The tool is used only for qualified health plan and mixed household cases.

In order to correctly file the documentation, the consumer’s name, date of birth, and case number should be on each page of the verification that is uploaded.

The verification upload tool cannot be utilized the same day an SEP is requested. Consumers should be able to upload consumer verification documents the day after requesting an SEP from MNsure.

The preferred way to use the verification tool is to wait for the consumer to receive their SEP notice from MNsure and use the information on that notice to fill out the information required to use the verification tool.

Supporting Documentation Upload Tool: Tips for Assisters

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The upload tool can be used without the SEP notice, but you will need the following information, which you can request when you call the ARC/Broker Line to report the SEP. Case number on the application. This number is also known as the

Integrated Case (IC) number. Name and date of birth of the primary applicant on the application.

Note: this may be different than the primary applicant on the enrollment.

If you are using the verification tool without a notice, skip the section asking to upload the first page of the verification notice.

Broker Line/ARC teams are unable to provide information on whether a verification has been received in real time. Please wait a few days and use the Case Status Request form for this information.

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MNsure released a Special Enrollment Period and Pre-enrollment Verification Guide for Assisters 2018 to provide assisters with resources to guide consumers through the process of applying for a special enrollment period through MNsure. Topics include: An overview of when a consumer should apply for a special

enrollment period through MNsure The types of qualifying life events that might trigger a SEP for a

consumer A walk-through of the new pre-verification process Sample notices for the SEP pre-verification process A guide to using the new documentation upload tool A list of documents consumers can submit to verify eligibility for

each SEP

SEP and Pre-Enrollment Verification Guide for Assisters

Thank you!

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Next webinar/conference call:

Wednesday, April 4

12:30 – 1:30 pm

Topic: Results from the 2018 Open Enrollment Assister Experience Survey