1. January Enrollment Knowledge Transfer 1095A’s and Special Enrollment Periods

2. Enrollment Knowledge Transfer January, 2018
Purpose: Provide updates and answer questions on the Healthplanfinder enrollment process after January 15th
Scope: Enrollment into qualified health plans – Qualifying Life Events (QLEs) and Special Enrollment Periods (SEPs)
Ongoing Occurrence: Monthly; the second Thursday 12:15-12:45

3. Resources Navigators: Contact your Lead Organization
Producers:
Others: Customer Support Center

4. A Key Items
January 23: Documents available in the Message Center
January 31: Will receive in the mail by this date
Note: Applicant’s with notification preference will not receive a mailed copy

5. How to request a 1095A correction
Submit a correction request:
Correction Request web form:
a-statement/
Washington Healthplanfinder Customer Support Center

6. Who can expect a document
All QHP enrollees will receive a 1095-A document
Note: Documents are issued per enrollment, by assistance unit

7. Who will not receive a 1095-A
Catastrophic Enrollments
KP WA Catastrophic 7150/0 (2017)
Core Basic Plus Catastrophic 17
Dental-only plans
Washington Apple Health recipients
Will receive a 1095-B from Health Care Authority
Coverage obtained off the Exchange

8. Reviewing the 1095-A form

9. 1095-A Form Header
If either are checked, this is a second document generated for this enrollment
Void: Indicates an enrollment that has since been cancelled after the first document.
Note: The document will still contain the original values as the original document, only this box indicates a now- cancelled enrollment
Corrected: Indicates an enrollment that has since been updated after the first document

10. 1095-A Form Part I: Recipient Information
Marketplace identifier: Washington Marketplace-assigned policy number: Enrollment ID Policy issuer’s name: Insurance company Policy start date: Household-level start date for the enrollment Policy termination date: Household-level end date for the enrollment

11. 1095-A Form Part I: Recipient Information
Correcting discrepancies:
Member-demographics can be updated at the time of tax filing
Address can be updated at the time of tax filing
Coverage start dates that are incorrect must be reviewed by HBE

12. 1095-A Form Part II: Covered Individuals
Subsidized: Individuals covered in the enrollment, in the same assistance unit of the document recipient
Non-Subsidized: All individuals covered on the enrollment
Covered individuals demographics: Masked except for the last 4 of SSN, Recipient’s date of birth: will only display if the SSN is not present
Coverage start/end date: Member-level coverage dates for the individuals listed

13. Single Tax Filer Scenario
Covered Individuals:
Primary Applicant, age 50, MFT
Spouse, age 50, MFT
Dependent, age 21, Dependent of Single filing Household
Dependent, age 15, DSH
Dependent, age 13, DSH
Health plan coverage dates: January 1 – December 31 (all individuals)
How many documents will generate for this enrollment?
How many covered individuals on each document?
Notes for speaker: PA is only tax filer in this scenario (this is not a case where the tax filer is single as in not married). Bottom line is there is 1 tax return for these 4 people.

14. Single Tax Filer Scenario
Covered Individuals:
Primary Applicant, age 50, Tax filing status: Married Filing Jointly
Spouse, age 50, Tax filing status: Married Filing Jointly
Dependent, age 15, Tax filing status: Dependent of someone in household
Dependent, age 13, Tax filing status: Dependent of someone in household
Health plan coverage dates: January 1 – December 31 (all individuals)
How many documents will generate for this enrollment?
One (1); this household has a single assistance unit
How many covered individuals on each document?

15. Single Tax Filer Scenario
Covered Individuals:
Primary Applicant, age 50, Tax filing status: Married Filing Jointly
Spouse, age 50, Tax filing status: Married Filing Jointly
Dependent, age 15, Tax filing status: Dependent of someone in household
Dependent, age 13, Tax filing status: Dependent of someone in household
Health plan coverage dates: January 1 – December 31 (all individuals)
How many documents will generate for this enrollment?
One (1); this household has a single assistance unit
How many covered individuals on each document?
Four (4) in the single document

16. Multiple Tax Filers Scenario
Covered Individuals:
Primary Applicant, age 50, Tax filing status: Married Filing Jointly
Spouse, age 50, Tax filing status: Married Filing Jointly
Dependent, age 21, Tax filing status: Single filing taxes
Dependent, age 15, Tax filing status: Dependent of someone in household
Dependent, age 13, Tax filing status: Dependent of someone in household
Health plan coverage dates: January 1 – December 31 (all individuals)
How many documents will generate for this enrollment?
How many covered individuals on each document?

17. Multiple Tax Filers Scenario
Covered Individuals:
Primary Applicant, aged 50, Tax filing status: Married Filing Jointly
Spouse, age 50, Tax filing status: Married Filing Jointly
Dependent, age 21, Tax filing status: Single filing taxes
Dependent, age 15, Tax filing status: Dependent of someone in household
Dependent, age 13, Tax filing status: Dependent of someone in household
Health plan coverage dates: January 1 – December 31 (all individuals)
How many documents will generate for this enrollment?
Two (2); this household has multiple assistance units
How many covered individuals on each document?

18. Multiple Tax Filers Scenario
Covered Individuals:
Primary Applicant, age 50, Tax filing status: Married Filing Jointly
Spouse, age 50, Tax filing status: Married Filing Jointly
Dependent, age 21, Tax filing status: Single filing taxes
Dependent, age 15, Tax filing status: Dependent of someone in household
Dependent, age 13, Tax filing status: Dependent of someone in household
Health plan coverage dates: January 1 – December 31 (all individuals)
How many documents will generate for this enrollment?
How many covered individuals on each document?
Four (4) and one (1)

19. 1095-A Form Part II: Covered Individuals
Correcting discrepancies:
I received multiple documents, but we are filing as one household: IRS Form 8962 Instructions includes this scenario
I received one document, but we are filing as separate tax household: IRS Form 8962 Instructions includes this scenario
Coverage start dates that are incorrect must be reviewed by HBE

20. 1095-A Form Part III: Coverage Information
Part III reflects the premium, benchmark premium used to calculate the subsidy, and the actual applied subsidy for the months corresponding to the date ranges and household composition listed in Part II

21. 1095-A Form Part III: Coverage Information
Essential health benefits (EHB) defined:
Ten categories of services health insurance plans must cover under the Affordable Care Act. These include doctors’ services, inpatient and outpatient hospital care, prescription drug coverage, pregnancy and childbirth, mental health services, and more.
Many health plans cover more services:
Insurance companies offer plans that cover more than just the essential health benefits, such as vision or acupuncture. These additional benefits are not eligible to receive a premium subsidy
EHB-adjusted premium:
Insurance companies factor in these additional services into the plan rates. Each plan has an EHB-adjusted premium between 100%-97%; which is the maximum amount of the premium eligible for a subsidy. Part III, Column A reflects this factored amount.

22. 1095-A Form Part III: Coverage Information
Pediatric dental is an essential health benefit:
For this reason, Part III, Column A will reflect the amount of any pediatric dental plan premium for the corresponding covered individual and coverage date ranges
Family (adult) dental is not included:
Dental premiums for enrollees 19 and over will not be included in Part III, Column A. Applicants that age-out of pediatric dental coverage and continue as family dental coverage will not have the premium included in Part III, Column A after the month of their 19th birthday.
Dependent plan rate capping applies:
Qualified health and dental enrollments with more than three individuals 20 years old and under are capped at the premium for three individuals. The amount in Part III, Column A reflects this rate capping.

23. 1095-A Form Part III: Coverage Information
Second lowest cost silver plan (SLCSP)
The advance premium tax credit is calculated as the difference between the expected contribution for the income and household size and the SLCSP premium for the QHP coverage-eligible individuals seeking coverage on the application. Part III, Column B reflects the value of the SLCSP premiums for those listed in covered individuals
SLCSP and multiple tax households
SLCSP is used to apportion premiums between the 1095-A forms for each tax household. Premiums on each form may not reflect the conventional age/location/tobacco premium breakdown for the members enrolled under each tax household.

24. 1095-A Form Part III: Coverage Information
Part III, Column C
Reflects the amount of applied tax credit (if any) for the enrollment months
APTC and multiple tax filing households
APTC is assigned to the Primary Tax Filer for the application, up to the EHB premium. Any additional APTC is assigned to the Secondary Tax Filer, up to the EHB premium. This APTC allocation occurs across assistance units until the APTC is exhausted.

25. 1095-A Form Part III: Coverage Information
Impact of non-payment (NP) terms on Part III, Columns A & C
Un-subsidized: Both Columns A and C reflect amounts that match the same coverage end date as their paid through date
Subsidized: Column A reflects their last paid month, Column C will be the last day of the first month of the 3-month grace period
Scenario:
Subsidized applicant has been terminated for non-payment effective 05/31/2018

26. 1095-A Form Part III: Covered Individuals
Correcting discrepancies:
Column A has the wrong or missing amount: This requires HBE review
Column B has the wrong or missing amount: This requires HBE review
Column C has the wrong or missing amount: This requires HBE review

27. What is a Special Enrollment Period?
A Special Enrollment Period is a time outside of Open Enrollment Period when a customer and their family maybe eligible to sign up for health coverage
In Washington Healthplanfinder, customers may qualify for a special enrollment period 60 days following the date of a qualifying life event
Special enrollment periods apply to customers seeking coverage in Qualified health and dental plans not Washington Apple Health (Medicaid)
Apple Health has year round Open Enrollment
Apple Health enrolled customers can also change their Managed Care Plan year round
Talking point:
Customers attest to their qualifying life event through Washington Healthplanfinder
Carriers may request documentation as proof of the qualifying life event. If the customer doesn't provide documentation directly to the carrier, the carrier may deny the special enrollment period
November 23, 2018

28. Qualifying Life Events
An individual/family may qualify by experiencing one of the events below
Marriage
Birth / Adoption
Removal of Household Member
Losing Minimum Essential Coverage
Reporting Domestic Violence
Permanent Move to & within Washington
Talking points:
Change in Household Taxes
Change in Lawful Presence/Citizenship Status
Change in Eligibility
The special conditions that qualify for special enrollment periods change from time to time due to federal and state policy changes, and may vary with complex scenarios (qualifying for more than one event)

29. Hierarchy of Qualifying Life Events
For customers reporting multiple qualifying life events, Washington Healthplanfinder will follow a hierarchy to determine the earliest possible start date for the customer 1
Retro Event
Birth 2
1st of Next Month Events
Marriage
Loss of Minimum Essential Coverage
Change in Program
Change of Location (New Plan, No Loss of Coverage)
Death 3
Cutoff Date Rule Events
Adding/Removing a Household Member
Change in Citizenship or Lawful Presence
Reconciling Taxes
Domestic Violence
Change in Income or Taxes – for current enrolled customers
November 23, 2018

30. Special Enrollment Questionnaire
New Customer
Current Enrolled
For new Apple Health/Qualified health plan customers outside of Open Enrollment (or customers experiencing a qualifying life event during Open Enrollment for current year), they will see the version on the left of the Special Enrollment Questionnaire page - read through and select appropriate answer for customer.
If Yes is selected for certain questions, additional information fields may appear asking for Date of Event or Date of Court Order
Some questions (i.e. Domestic Violence) will not need additional information aside from self-attestation.
Selecting answers:
A customer can select multiple events at one time on this questionnaire; from there, Washington Healthplanfinder will determine the “best possible” or “better” event for coverage start date(s).
A customer can also select nothing at all (questions are not marked as required). They can click Next to navigate forward (assume all answers are null) or Cancel to go back to the dashboard (still have 30 days to answer questionnaire if needed).
For currently enrolled Qualified health plan/Apple Health customers (during or outside of Open Enrollment), there are additional questions (read through select questions)
Based on changes reported in the earlier form, as detected by the Washington Healthplanfinder system, some questions may come with prepopulated answers
If Yes is selected for certain questions, additional information fields will appear asking for Date of Event or Date of Court Order
However, some questions (i.e. Domestic Violence) will not need additional information aside from self-attestation.
A customer can select multiple events at one time on this questionnaire; from there, HPF will determine the “best possible” or “better” event for coverage start date(s)

31. Providing Date of Event
This modal will pop up if the customer does not provide a Date of Event, as required for most qualifying life events
Some SEQs may come prepopulated with previously provided information for certain questions and require a Date of Event.
When submitting the special enrollment questionnaire, there are potential modals that may pop up when the customer clicks Next
The “Provide Date of Event(s)” modal will pop up if the customer does not provide a Date of Event as required for some qualifying events. Some SEQs may come prepopulated with previously provided information for certain questions and require a Date of Event (some customers may not notice this page update)

32. Results – Outside of Open Enrollment
Depending on when the Special Enrollment Questionnaire is submitted, the approval and denial messaging will vary
Approved
Denied
After submitting the special enrollment questionnaire, the approval or denial messaging screen will display and vary based on Open Enrollment period.
The customer would click Next and be directed to select a plan (if approved Special Enrollment Period) or to the individual dashboard (if denied Special Enrollment Period)

33. Additional Special Enrollment Resources
Washington Health Benefit Exchange Corporate Website: customers/who-can-sign-up/special-enrollment-period/special-enrollment-qualifying-events/

35. Appendix