1. Hardship Exemption and Catastrophic Plans
Enrollment Knowledge Transfer June 14,2018
Hardship Exemption and Catastrophic Plans
Presented by: Kathy Goldenberger / Enrollment Analyst

2. Coverage Exemptions
Most people who don't have qualifying health coverage must either pay a fee or qualify for an “exemption.”
Health coverage exemptions are available for a variety of reasons: certain life events, health coverage or financial status, group membership, and more. If the applicant qualifies, they don’t have to pay the penalty for the months they were uncovered and the exemption applies.

3. Coverage Exemptions All exemptions are filed on Form 8965
However, certain types of exemptions require an Exemption Certificate Number (ECN)
ECNs are issued by the Federally Facilitated Marketplace (FFM - FEDERAL Marketplace)
Exemptions are by person at the household level
Each individual will be issued a unique ECN if their Exemption is approved by the FFM
In some cases of WAHBE error and carrier errors, WAHBE can provide a letter to support an exemption from the IRS. This is on a case by case basis and must be requested and approved by WAHBE Leadership.
Bullet 2 Certain types – Hardship Exemption, must be provided by the FFM as a ECN needs to be provided.
Exemptions are on an individual basis.
Bullet 6 – Customers should call the call center and make their request. This request will be forwarded to the Level 2 Operations team for analysis and approval process.

4. Coverage Exemptions
Any exemptions filed with a tax return must be filed on form If someone has a letter of support from the WAHBE, they would still complete this form and provide the letter to support an exemption.

5. Hardship Exemptions
Customer has experienced financial or domestic circumstances, including an unexpected natural or human-caused event, such that he or she had a significant, unexpected increase in essential expenses that prevented him or her from obtaining coverage under a qualified health plan;
The expense of purchasing a qualified health plan would have caused him or her to experience serious deprivation of food, shelter, clothing or other necessities; or
He or she has experienced other circumstances that prevented him or her from obtaining coverage under a qualified health plan.
Hardship exemption MUST be provided by the FFM.

6. CATASTROPHIC PLANS

7. Catastrophic Health Plans
Catastrophic health plans have lower monthly premiums but higher deductibles, co-payments, and co-insurance. You cannot use a premium tax credit to reduce your monthly cost for a catastrophic plan.
To qualify, you must be under 30 years old OR get a hardship exemption based on your income. No

8. Catastrophic Health Plans (continued)
At this time, Kaiser Permanente is the only carrier issuing Catastrophic Health Plans. Here is an example of costs and deductibles: 28 y/o female – no tobacco use

9. Catastrophic Health Plans (continued)
28 y/o female – no tobacco use

10. Comparisons – which is the best option?
Married Couple – both non-tobacco users, living in Seattle, WA. One is age 29, one aged 27, Income $ 40,000.00
Catastrophic Plan Premium: APTC: 0 Responsibility: $381.19
Flex Silver Plan
Premium:
APTC:
Responsibility: $383.98
(Cost Sharing Reductions Eligible)

11. Catastrophic to Silver Comparison
Flex Silver
Deductible -$7,350 /$14,700 Out of Pocket Max - $7,350
Deductible - $1,500 / $3,000 Out of Pocket Max - $5,700

12. Catastrophic to Silver Comparison
Flex Silver
Deductible -$7,350 /$14,700 Out of Pocket Max - $7,350
Deductible - $1,500 / $3,000 Out of Pocket Max - $5,700

13. Catastrophic to Silver Comparison
Flex Silver
Deductible -$7,350 /$14,700 Out of Pocket Max - $7,350
Deductible - $1,500 / $3,000 Out of Pocket Max - $5,700

14. Catastrophic to Silver Comparison
Flex Silver
Deductible -$7,350 /$14,700 Out of Pocket Max - $7,350
Deductible - $1,500 / $3,000 Out of Pocket Max - $5,700
In Network
Out of Network

15. Catastrophic Plans for Individuals who are Over 30
Through the FFM, an individual or family can be approved for a Hardship Exemption and receive a ECN.
If they are over 30, our system is not designed for that – they must request assistance.
Customers should call the Call Center with their ECN already assigned.
A ticket will be generated for an Enrollment Analyst to assist your customer.
ECN #
FFM

16. Customers can only get exemptions from the Washington Health Benefit Exchange/Healthplanfinder.
TRUE or FALSE
Quick

17. Customers can only get exemptions from the Washington Health Benefit Exchange/Healthplanfinder.
FALSE – Hardship exemptions need to go the FFM to get an ENC # to make application.
Quick

18. 2. Customers can only get exemptions from the Federally Facilitated Marketplace.
TRUE or FALSE
Quick

19. Quick
Customers can only get exemptions from the Federally Facilitated Marketplace.
FALSE – Letters to support an Exemption can be provided by the WAHBE / HPF if there are documented system issues or carrier error that affected individuals enrollment 3 months or more.

20. Only customers under 30 can purchase CATASTROPHIC plans.
TRUE or FALSE

21. REMEMBER – customers over 30 will need HPF assistance.
FALSE – although the Catastrophic Plans are designed for people who are young, healthy and seldom go to the doctor - customers over 30 CAN qualify to purchase a Catastrophic Plan by obtaining a ECN exemption from FFM – the Federally Facilitated Marketplace.
REMEMBER – customers over 30 will need HPF assistance.
Only customers under 30 can purchase CATASTROPHIC plans.
TRUE or FALSE

22. Resource Page Health Coverage Exemption Form
Health Coverage Exemption Information
Catastrophic Plan Information
Appreciate the links.