Nevada Broker / agent Health Exchange On Boarding Session 2
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Transcript of Nevada Broker / agent Health Exchange On Boarding Session 2
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Broker & Agent Onboarding - Session 2
July 31, 2013
Enrollment and Payments for Individuals & Small Business
Health Options Program (SHOP)
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Agenda 1. Broker Portal
2. Individual Open Enrollment Periods 3. Individual Special Enrollment Periods 4. SHOP Employer Enrollment and Employee Open Enrollment 5. SHOP Employer/Employee Choice Models 6. SHOP Minimum Contribution and Participation Rates 7. Special Enrollment for SHOP 8. SHOP Renewals
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Broker Portal • Brokers and agents will manage
Exchange clients on the Exchange website Broker/Agent portal to include: • Run proposals • Sales • Enrollment • Premium payment tracking • Service issues
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Broker Portal Screenshot
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Broker Login & License Validation
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Individual Open Enrollment Periods
October 2013: Brokers & agents will be able
enroll individual clients in a health insurance plan using the broker & agent portal. December 15, 2013: Clients signed up for insurance by December 15, 2013 will have coverage on January 1, 2014. March 31, 2014: Enrollment closes for individuals until it reopens in the next open enrollment season (October 15 – December 7).
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Individual Open Enrollment Eligibility
Eligibility for a Qualified Health Plan: • United States citizen, national, or lawfully
present • Cannot be incarcerated (unless awaiting
disposition of charges) • Must be a resident or intend to reside in
Nevada
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Individual Special Enrollment Periods
Triggers: • Birth, Adoption or Placement for Adoption • Marriage / Domestic Partnership • Loss of Minimum Essential Coverage • Gains Citizenship, National, or Lawful Presence • Unintentional, Inadvertent, or Erroneous Enrollment/
Non-Enrollment as a Result of Nevada Health Link or HHS
• QHP Substantially Violates a Material Provision of the Contract
• Change in Eligibility for APTC/CSR • Employer Plan Unaffordable • Permanent Change in Residence to a New Service Area • American Indian/Alaskan Native • Other exceptional circumstances
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Individual Special Enrollment Periods, cont.
Length of Period: enrollees are provided 60 calendar days after the date of a qualifying event to complete a plan selection. Effective Date of Coverage: • Birth/Adoption/Placement for Adoption – day of the
event. • Marriage/Domestic Partnership/Loss of MEC - first day
of the month following the qualifying event date. • All others:
• If the date the plan selected was completed between the 1st – 15th, the date of coverage is the first day of the following month.
• If the date the plan was selected was completed between the 16th – 31st, the date of coverage begins the month after the following month.
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SHOP Employer Enrollment and Employee Open Enrollment
• Initial Open Enrollment begins October 1, 2013, with the first effective date of coverage beginning January 1, 2014
• A qualified employer may purchase coverage for its small group at any point during the year
• The employer’s plan year will consist of the 12-month period beginning with the qualified employer’s effective date of coverage
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SHOP Employer Enrollment and Employee Open Enrollment, cont.
• Employers must select a purchasing model to offer to their employees at least 60 days prior to requested effective date of coverage
• Employees will be provided 30 days to select a QHP option from the employer’s selected purchasing model and complete the application process
• Employer’s enrollment and initial payment to the Exchange must occur at least 15 days prior to the effective date of coverage
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SHOP Employer/Employee Choice Models
Four Purchasing Options: • Open Metal Tier • Open SHOP • One Carrier Package • Carrier Partnership Package Premium aggregation will be provided starting in 2014 for all purchasing options. Sample plans:
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Example SHOP QHP Purchasing Model Options
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SHOP Minimum Contribution and Participation Rates
Employer • All plans in the SHOP Exchange have a
standard minimum employer contribution rate of 50% of the lowest cost QHP available to the employer’s employees.
• Minimum employee participation rate of 75% of
eligible employees.
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SHOP Eligibility Employee • Must receive an offer of coverage from a
qualified employer • Must be an eligible employee as defined by
the employer • New Group - Must be hired before the
group’s effective date of coverage • Existing Group - Must complete the group’s
waiting period if a new hire – or have a Special Enrollment event
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SHOP Eligibility, cont. Spouse • Legally married to employee • Domestic Partner is at the option of the
employer Dependents • Children (born to, adopted, or legal
guardianship) ages 0-25 • Disabled (must be declared disabled by
SSA prior to enrollment and submit proof)
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Special Enrollment for SHOP
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Special Enrollment for SHOP, cont.
Employer • All plans in the SHOP Exchange have a
standard minimum employer contribution rate of 50% of the lowest cost QHP available to the employer’s employees.
• Minimum employee participation rate of 75% of
eligible employees.
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SHOP Renewals • The Exchange will send renewal information
to the employer approximately 90 days prior to plan year end
• The Employer will have 30 days to submit changes to Purchasing Model & make changes to contributions
• The Employee will have 30 days to submit renewal changes
• If the employee does not submit changes, the employee’s plan will auto renew. If the plan the employee is enrolled with is no longer available, the employee must make a new plan selection.
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Submitted Q & A
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Nevada Health Link Silver State Health Insurance Exchange 2310 South Carson Street, Suite 2 Carson City, NV 89701 [email protected] http://exchange.nv.gov/Resources/Brokers_Agents/
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NevadaHealthLink.com