Reporting Account and enrollment changes ( aec )

1. Reporting Account and enrollment changes (aec)

2. Objectives • Provide an overview of the types of changes that can be reported and when • Provide an overview of the AEC reporting process • Familiarize you with the Report Account and Enrollment Changes (AEC) Form • Direct you to the right sections of the Form, depending on the AEC being reported • Provide instructions on filling out the Report AEC from

3. Expectations • Manual change reporting process • Not real time • Reporting changes through PEAK • Upcoming PEAK webinar • Answering question on process as is, separate opportunity for comments

4. Definitions Coverage Effective Date Rules follow the 1-15th of the month; 16th-end of the month logic. Qualified Life Change Event is a change that allows new and current customers to enroll in or update health care coverage outside of an open enrollment period. Cancellationsmay be made if the consumer has not yet paid to finalize their enrollment.  During the open enrollment window, selection of a new plan is allowedafter a cancellation. • if cancellation is wanted before plan effective date, consumer can make the change using the PDF Change Form or by calling the Service Center • if cancellation is wanted after plan effective date, consumer can make the change using the PDF Change Form or by calling the Service Center

5. Definitions Terminationsoccur after the consumer has made a payment to the carrierto finalize coverage.  • The consumer must will select the desired end date at a minimum of 14 days before they want their coverage to end Special Enrollment Period is a period of time outside of the Open Enrollment period where consumers have an opportunity to shop or re-shop for plans. The current customer can choose to change plans or stay with existing coverage.

6. Policies

7. Initial Enrollment Timelines(in open enrollment) Individual Marketplace: • Enroll between the 1-15th of any month, coverage must be ensured the first day of the following month. • Enroll between the 16th and last day of the month, coverage must be ensured the first day of the second following month. *In order for the effective date to remain and go into effect, the PAYMENT for the Individual must have been successfully processed. SHOP Marketplace: • Small employers and employees will be required to provide information to the Marketplace by the 15th of the month. • Initial enrollment information provided to the Marketplace by the 15th would trigger effective coverage for the 1st of the next month. • Employee information will only be sent to carriers once full payment has been received from the employer. *In order for the effective date to remain and go into effect for the group, the employer must pay in full by the 25th of the month before coverage.

8. Post Enrollment Changes (in open enrollment) Individual Marketplace: • During open enrollment, customers may cancel/terminate coverage and will be allowed to enroll in new coverage subject to Coverage Effective Date Cut Off rules (Warning: A gap in coverage may occur.) • During open enrollment, a customer with a Qualified Life Change Event may update coverage that is not subject to the Coverage Effective Date Cut off. • Births or Adoptions, the effective date of coverage is the date of the event. • All other Qualified Life Change Events are effective the first of the month following the reported Qualified Life Change Event. • Example: Customer reports to C4HCO that they need to add their new spouse (Qualified Life Change Event = Marriage) on February 23. The coverage effective date for this change is March 1 because the change is classified as a Qualified Life Change Event.

9. Post Enrollment Changes (in open enrollment) SHOP Marketplace: • During open enrollment period, customers are able to enroll in coverage at any time. • During open enrollment, a customer with a Qualified Life Change Event may update coverage or select new coverage. • Births or Adoptions, the effective date of coverage is the date of the event. • All other Qualified Life Change Events are effective the first of the month following the reported Qualified Life Change Event. • During open enrollment, customers may cancel/terminate effective coverage and will be allowed to enroll in new coverage prior to the close of the enrollment period.

10. What Changes are Accepted During Open Enrollment (OE) for Individual and SHOP marketplaces? ANYTHING! But here are some examples: • Adding/removing dependents • Loss of other coverage under Medicaid/CHP+ • Permanent change in residence • Erroneous enrollment • Customer wants a new plan • Income change* • Received a hardship/affordability exemption and wants a CYA plan* • Data entry error (ex. entered wrong SSN or birth date) • Adding/removing dental • Customer forgot to run plan selection by spouse • Provider isn’t in the plan like they thought • Changes to a roster** *Individual market only **SHOP market only

11. Post Enrollment Changes (outside OE) Individual Marketplace: • New customers (who are not American Indian or Alaska Native) are not allowed to enroll in new Medical coverage without a Special Enrollment Period. • New and current customers (who are not American Indian or Alaska Native) may only initiate Special Enrollment Periods to enroll in new coverage or change existing coverage due to a Qualified Life Change Event. • When a customer is allowed to shop as a result of a life change they have a 60-day shopping window from the date of the life change event. • Customers may voluntarily terminate existing coverage, but are not allowed to enroll in new Medical coverage • Customers can enroll in Dental coverage at any time during the year. Effective date of change is always the first of the following month (except birth/adoption)

12. Post Enrollment Changes (outside OE) Small Business Marketplace: • New employee hires can enroll in SHOP coverage at any time • Employers can set effective dates for eligible new employee hires as early as the 1st day of month following the date of hire and as late as the 1st day of the month following 60 days of hire. • Current, enrolled employees must submit a Qualified Life Change Events for the SHOP to open a Special Enrollment Period. • When an employee is allowed to shop as a result of a life change they have a 30-day shopping window from the date of the life change event. • Employees can enroll in Dental coverage at anytime during the year. Effective date of change is always the first of the following month for current employees

13. Changes are Accepted OUTSIDE of open enrollment (Qualified Life Changes) Allows current enrollees to shop for a new plan: • Marriage or civil union or domestic partnership • Birth or adoption or placement for adoption • Change of AI/AN status • Change of residence (if moving out of a service area) • Gain or loss of eligibility for the tax credit or cost sharing reduction • Loss of eligibility for the hardship exemption making you ineligible for your CYA (catastrophic) plan • A customer is inadvertently or inappropriately enrolled or not enrolled in a health plan as a result of error, misrepresentation, or inaction by the Marketplace or one of its instrumentalities • A customer demonstrates that their health plan has substantially violated a provision of its contract.

14. Changes Accepted OUTSIDE open enrollment • Allows current customers to Update current plan (meaning they can’t select a new plan): • Removal of dependent due to divorce/annulment/separation • Removal of dependent due to child age out (dependent turns 26) • Removal of dependent due to death • Allows new customers to Shop for a health plan: • Loss of minimum essential coverage (MEC) • Employer-sponsored coverage becomes unaffordable • Gain of Citizenship or Immigration status • Change in incarceration status • Loss of eligibility for the exemption to purchase health insurance coverage • A customer demonstrates that their health plan has substantially violated a provision of its contract • Move to Colorado

15. Other Notes on Changes • If you are OUTSIDE of your 30 or 60 day window to report a change, still report your change so your account can be updated. • For the Individual market, if your change leads to a change in FPL, your APTC can still be adjusted but plan shopping will not be an option. • Changes not mentioned: WHEN IN DOUBT, REPORT IT.

16. To Summarize…. • Enrolled customers can submit any type of change to enrollment during the open enrollment period • Effective dates for changes during open enrollment depend on whether the change is a Qualified Life Change Event or not. • If it isn’t, then the effective date will follow the 15th/16thlogic • If the change is a QLCE, the change will be effective the 1st day of the following month • C4HCO will only accept Qualified Life Change Events outside of the open enrollment period in the Individual and SHOP marketplaces. All reported Qualified Life Change Events will be effective the first day of the following month .

17. Processes Reporting AEC on the Individual Market

18. I have a change… What Next? • Fill out the Account and Enrollment Changes Form • Submit Form to the Marketplace • The Marketplace Processes the Form RESULTING IN Option to Shop for a New Plan OR No New Plan Shopping

19. OVERVIEW: NO need to report change through PEAK

20. OVERVIEW: Customer must report change through PEAK

21. PEAK and Reporting Changes • Customers will need to report changes through PEAK if the change could affect eligibility for Medicaid or CHP+. Changes include adding or removing household members or DECREASES in income. • If any of the members of the tax household currently have Medicaid or CHP+, then use ‘Report My Changes’ in PEAK. • www.Colorado.gov/PEAK > “Manage My Account” > log in to account (or creates new account if customer does not already have one) > “Report My Changes”

22. PEAK and Reporting Changes • If NO tax household members currently have Medicaid or CHP+, then need to submit a NEW medical application through PEAK  to report the change. • If the customer does not have access to a computer, they can call the Medicaid Call Center (1-800-221-3943) for more information or submit the change or a new application, as applicable, to their county of residence.

23. What is the Report AEC Form? The AEC Form is a paper form designed to capture three types of information: • Requests to update/modify incorrect customer information • General changes • Qualifying Life Change Events

24. Who May Use the AEC Form? • Current Customers insured through the Marketplace • Current Marketplace Customers without Financial Assistance but whose change may allow them to get Financial Assistance • New applicants whose change allow them to enter the Marketplace to access health insurance

25. Who May Fill Out Report AEC Form? • Current/Future Customers or their authorized representative • Someone working on Customer’s behalf • Agents/Brokers • Customer Service Representatives • Certified Application Counselors and Health Coverage Guides may assist customers in filling out the form themselves

26. Where Do I find the Report AEC Form?

27. Where to start filling out the AEC Form OR

28. Authorized Representative – Worksheet D

29. Application Counselors, Health Coverage Guides, Agents, Brokers – Worksheet D

30. Customer – Part A

31. Scenarios/what to fill out in Part A

32. Part B: What is the Kind of AEC Reported? Gain other MEC Loss of MEC Pregnancy Income Dependents Marital Status Other LCEs Incarceration Change in Residence/Mailing Address Lawful Presence General Account / Application Changes / Corrections

33. Type of LCE - Part B - 1 Customer will be asked if they would like to keep their current plan, if possible.

34. Type of LCE - Part B - 2

35. Pregnancy Reporting a pregnancy cannot be used to determine the availability or cost of any health insurance purchased through Connect for Health Colorado, but it can give greater access to State programs at a higher Federal Poverty Level.

36. Marital Status Changes Marital Status Change

37. Marital Status LCE *Other worksheets should be filled out as applicable.

38. For Marital Status Changes *Other worksheets should be filled out as applicable.

39. Part C

40. Part D - 1

41. Part D - 2

42. Worksheet B – Sub-Section A

43. Worksheet B – Sub-Section B

44. Worksheet B – Sub-Section B (continued)

45. Worksheet B – Sub-Section C

46. Change in Number of Dependents *Other worksheets should be filled out as applicable.

47. Loss of Minimum Essential Coverage *Other worksheets should be filled out as applicable.

48. Gain Other Minimum Essential Coverage

49. Lawful Presence *May now be eligible to receive Medicaid or CHP+

50. Change in Income – Part 1