Community Partner Webinar July 2, 2014

COMMUNITY PARTNER WEBINAR JULY 16, 2014

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• Small Business Health Options Program (SHOP) Outreach and Education Grantees

• Program Updates: – Recertification

– Remote Identity Proofing

– 2015 Renewals

• Responses to Your Questions from the Last Webinar

• Covered California Testimonials

• Resources

• Questions & Answers

AGENDA

SMALL BUSINESS HEALTH OPTIONS PROGRAM (SHOP) OUTREACH AND EDUCATION GRANTEES THEIR ROLE AND HOW OTHER PARTNERS CAN WORK WITH THEM

What you need to know for your business and your

employees

What the Healthcare Law Means for California Small Businesses

California Hispanic Chambers of Commerce

• The California Hispanic Chambers of Commerce represents the interest of over 600,000 Hispanic business owners in California

• Premier and largest regional ethnic business organization in the nation that promotes the economic growth and development of Hispanic entrepreneurs and California’s Emerging Businesses.

• Promote, support and encourage the advancement and development of Hispanic and minority owned businesses

Small Business Majority, California Hispanic Chambers of Commerce, CalAsian Chamber, Covered California

• The CalAsian Chamber’s mission is to grow and empower the Asian Pacific Islander business community throughout California.

• Access – Represent the interests of the nearly 600,000 API owned businesses in the State of California.

• Education – Provide API owned businesses with the tools necessary for success.

• Opportunity – Connect API owned businesses with opportunities to grow their business.

CalAsian Chamber of Commerce


• Small business advocacy organization – founded and run by small business owners

• National – based in CA – with additional offices in Washington, DC, NY, OH, CO and MO

• Research and advocacy on issues of top importance to small businesses (<100 employees) and the self-employed

• Very focused on outreach to and education of small business owners across the country

Small Business Majority


Small firms pay 18% more than large businesses

29.5% self-employed: uninsured (CA: 826,000)

25% of small employers: uninsured (CA:175,000)

Small Business Majority opinion survey: 86% of CA small businesses don’t offer because of cost; 70% of those who do offer say they are struggling to do so

Small Business Majority national 2008 study: Small business health costs would more than double by 2018 without any reforms – 5X rate of inflation – $2.4 trillion nationally ($243 billion in CA)

Small businesses – struggling with costs


• Affordable Care Act Consumer Protections

• Cost Containment Provisions

• Employer Responsibilities

• Individual Responsibility (incl. self-employed)

• Small Business Tax Credits

• Health Insurance Marketplace

• Covered California

• SHOP

• Questions and Comments

Topics for Discussion


Businesses with fewer than 50 full-time workers – 96% of all businesses – are exempt from any requirement to offer insurance

Businesses with 50-99 employees required to offer in 2016

Businesses with more than 100 employees required to provide insurance to 70% of employees in 2015, 95% in 2016 and beyond


Employer shared responsibility For larger employers – January 1, 2015

Am I above or below 50 full-time employee threshold? At least 50 full-time employees or combination of full-time/part-time employees

equivalent to 50 full-time employees; Full-time work week is 30 hours per week. Size of firm determined annually; Fee (if any) determined monthly

Potential Penalty:

Failure to offer coverage Failure to offer “affordable” coverage that provides minimum value*

$2,000* per year for each full time employee per year, excluding first 30

full time employees

$3,000 per year for each full time employee receiving premium assistance in Marketplace

• * Firm pays penalty if at least one employee qualifies for premium assistance in Marketplace.

• *Affordable – Employee’s share of premium does not exceed 9.5% of employee annual income (not household)

• Minimum value – Plan covers at least 60% (average) of healthcare expenses


Employer shared responsibility – For larger employers

• Employee Notifications – www.dol.gov/ebsa/healthreform Employers required by the Fair Labor Standards Act (FLSA) to notify employees by Oct. 1, 2013 of coverage options available through the Insurance Marketplace.

• Two notices available: 1) For employers who do offer coverage 2) For employers who do not offer coverage

• Summary of Benefits and Coverage Insurers provide employers a summary of benefits; employers must share info with workers (Sept. 2012)

• W2 reporting (for larger employers) – Informational only

• Allows workers to see how much employer is spending on health benefits

• Firms with fewer than 250 workers exempt until further notice


Employer Responsibilities

Which businesses & non-profits are eligible?

Fewer than 25 full-time employees

Average annual wages <$50,000

Employer pays at least 50% of employee premium cost

Available now (took effect tax year 2010)

• $40 billion in credits by 2019


Small business tax credits

Tax credits on a sliding scale:

o Up to 35% 2010–13

o Up to 50% any two consecutive years beginning 2014 (in SHOP marketplace)

Tax credits do not cover premium expenses of owners or their families

Can amend taxes for past years

Our report – 375,310 CA businesses are eligible (70% of all small businesses); 158,000 CA businesses eligible for the maximum credit


Small business tax credits

• A marketplace where small businesses can choose from multiple health plans that provide the best value for their employees, with simple and easy-to-use enrollment tools.


Small Business Health Options Program (SHOP)

Employer Defined Contribution • Employer selects a metal tier or “benchmark” plan

and the percentage they want to contribute to their employee’s premium.

• Employer wins: Predictable costs and set budget

Employee Choice • Employee selects any plan within the employers

benchmark plan. • Employee wins: Freedom to choose their own plan


SHOP

Individual Marketplace

SHOP Marketplace


2014 Providers

Employer Eligibility – • 2-50 employees

(at least one W-2 employee);

• Majority of employees in CA;

• Legitimate employer-employee relationship

• Small business entities accepted – Sole Proprietor, Corporations, Partnership, Limited Partnership (LP), Limited Liability Partnership (LLP), Limited Liability Company (LLC)

Employee Eligibility • Eligible – Full-time permanent employees working 30 hours per week;

Part-time employees (at employer’s discretion) working 20-29 hours per week

• Not eligible – 1099 employees, seasonal and temporary employees


SHOP Eligibility

Enrollment date – Option to enroll anytime, according to current policy’s renewal date, or at another date selected


SHOP Enrollment

• Employer completes SHOP Employer Application; Employees complete SHOP Employee Application • Applications can be filled out online, by phone, fax,

or paper • Once enrolled, employer’s coverage and premiums

are set for 12 months

Enrollment support • Certified insurance agents provide valued service in determining best plan

based on needs/budget; offer solutions in and outside Covered California.

Have completed Covered California Training & Certification

Provide valued service (not just enrollment)

Can offer solutions in and outside of Covered California

Are experts in both individual and group markets


Certified Insurance Agents

California Hispanic Chambers of Commerce

Waynee Lucero, Program Manager

[email protected] (916) 444-2221

Covered California: www.CoveredCA.com

SBM Website: www.SmallBusinessMajority.org

Statewide in-person presentations

Weekly webinars in English & Spanish

California Asian Chamber of Commerce: www.calasiancc.org

Information on Public Policy and International Trade

CA Hispanic Chambers of Commerce: http://www.cahcc.com/

Small Business Majority

Mark Herbert, Project Manager [email protected]

(916) 668-9630

California Asian Chamber of Commerce

Pallavi Shimoda, Director of Programs [email protected]

(916) 247-1649


Resources

mailto:[email protected]

http://www.coveredca.com/

http://www.smallbusinessmajority.org/

http://www.calasiancc.org/

http://www.cahcc.com/



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SHOP OUTREACH AND EDUCATION GRANTEES

QUESTIONS FOR THE SHOP GRANTEES?

SUBMIT QUESTIONS VIA THE QUESTION BOX.

PROGRAM UPDATES: RECERTIFICATION TRAINING & EXAM

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RECERTIFICATION TRAINING FOR CECS

Recertification Training • Required for Certified Enrollment Counselors (CECs) &

Plan-Based Enrollers (PBEs)

• Not required for Certified Educators

• Interactive Computer-Based Training (CBT) course

• Notification to access the CBT online in the Learning Management System (LMS)

• Approximately 3 hours to complete

• Includes an exam

• Tentative start date will be in September of 2014

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Recertification Questions • How many attempts will be allowed for CECs

and PBEs who fail the recertification exam?

Three (3) attempts to pass the exam with a score of 80% or higher for the first time they’re taking the recertification exam.

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Recertification Questions • What is the window of time for CECs and PBEs

to complete Recertification Training once it is made available in LMS?

PRIOR TO November 30, 2014.

EXCEPTION: CECs and PBEs that completed their “Certification” after September 30, 2014 do not need to “Recertify” until the next calendar year.

PROGRAM UPDATES: REMOTE IDENTITY PROOFING

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REMOTE IDENTITY PROOFING

JOB AID: REMOTE IDENTITY PROOFING • Effective Early August 2014 • Once implemented, any consumer submitting an application

or reporting a change must submit identity proofing. Only need to provide identity proof once.

• Individual Market only; Not applicable to SHOP applicants • The applicant or CoveredCA.com users, including CECs and

PBEs, will assist with verifying the applicants identity. • Steps for identity proofing during the application process

and more detailed information will be provided at the July 30 webinar.

PROGRAM UPDATES: 2015 RENEWALS

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2015 RENEWAL: CONSUMER JOURNEY

Update info Eligibility Enroll, plan selection Get confirm notice

Dates Activity

August 1 Proposed 2015 Covered California individual market issuers, products and rates made public

October 1 Individual market rates finalized

October 1 Recertification training completed for enrollment assistance personnel

October 1 – November 15

Redetermination notice period

November 15 Open enrollment begins

November 1 QHPs send renewal notice to members (meeting 60 day requirement)

December 15 Last day for plan change for coverage effective January 1, 2015*

*Individuals who are eligible for renewal but who cannot be passively reenrolled may face a gap in coverage if they do not select a plan by December 15, 2014

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2015 RENEWAL: CONSUMER JOURNEY

Update info Eligibility Enroll, plan selection Get confirm notice

10/1 – 11/14: Consumers receive renewal packets from Covered CA

8/1: Covered California prepares enrollees for renewal

Summer: Enrollees update authorization to use tax data

10/1 – 12/15: Consumers update eligibility information (if needed) and make plan changes (if needed/desired)

Start

Late December: Consumers pay January 2015 premium to

effectuate coverage for 1/1/15

COVERED CA TESTIMONIALS

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• What: Covered California is looking for individuals enrolled through the Exchange who are willing to publicly share their health coverage story.

• Who: DB Casting Agency is helping Covered California find these candidates. Dina Buglione or Victoria Murphy from DB Casting may

contact you to see if you know anyone who may be a good candidate and get a referral.

• Why: Helps Covered California develop a compelling message, and spread the word about Covered California and the value of affordable health coverage.

• When: Now!

Your help will be greatly appreciated!

COVERED CA TESTIMONIALS

RESOURCES

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The Health Consumer Alliance (HCA) is a partnership between Legal Aid organizations.

• HCA provides free local assistance to individuals and families applying for or enrolled in Covered California or Medi-Cal.

• CECs may refer consumers to HCA for additional help and information.

• Go to www.healthconsumer.org for contact information by county OR call 1-888-804-3536.

HEALTH CONSUMER ALLIANCE

http://www.healthconsumer.org/

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California Department of Managed Health Care (DMHC) The state department that regulates and license health insurance carriers and helps California consumers resolves problems with their health plan. Individual Consumers: Learn about your health care rights, consumer complaints & and independent medical review requests questions VOICE: 1-888-466-2219 | FAX: 916-255-5241 | TDD: 1-877-688-9891 MAIL: Department of Managed Health Care California Help Center 980 9th Street, Suite 500 Sacramento, CA 95814-2725 WEBSITE: www.dmhc.ca.gov

DMHC

http://www.dhcs.ca.gov/

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California Department of Insurance (CDI) The state department that regulates and license health insurance carriers.

Consumer Services Division: The Consumer Services Division (CSD) is responsible for gathering and responding to consumer inquiries regarding insurance company. MAIL: California Department of Insurance Consumer Services Division 300 South Spring Street, South Tower, Los Angeles, CA 90013 Fraud Division: Information concerning suspected insurance fraud should be directed to the addresses below. MAIL: California Department of Insurance Fraud Division 9342 Tech Center Drive, Suite 100, Sacramento, CA 95826 EMAIL: [email protected] WEBSITE: http://www.insurance.ca.gov/0100-consumers/

CDI


http://www.insurance.ca.gov/0100-consumers/





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Department of Health Care Services (DHCS) DHCS is a state department that oversees health care programs for low-income families, children, pregnant women, seniors, and persons with disabilities. DHCS administers the Medi-Cal Program. Medi-Cal Program Members: Call the Medi-Cal Program Service Center to:

• Learn how to apply for Medi-Cal • Learn about Medi-Cal services • Find a health care provider • File a complaint

VOICE: 1-800-541-5555 (outside of California, please call 916-636-1980) for our Telephone Service Center. EMAIL: [email protected], or contact your local county office from our County Listings page. WEBSITE: www.dhcs.ca.gov Listing of Local County Medi-Cal Offices: View the website link below to see the address and phone numbers for each Medi-Cal Office. http://www.dhcs.ca.gov/services/medi-cal/Pages/CountyOffices.aspx

DHCS





http://www.dhcs.ca.gov/services/medi-cal/Pages/CountyOffices.aspx



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For more information on Special Enrollment go to: http://www.coveredca.com/faqs/special-enrollment/ https://www.coveredca.com/coverage-basics/special-enrollment/ https://www.coveredca.com/FAQs/cobra/ For more information on the Navigator Program: http://hbex.coveredca.com/navigator-program/ For more information on Medi-Cal and pregnancy: https://www.coveredca.com/faqs/Medi-Cal/ http://www.dhcs.ca.gov/ For more information on prescription drugs: http://www.coveredca.com/faqs/prescription-drugs/

COVEREDCA.COM RESOURCES

http://www.coveredca.com/faqs/special-enrollment/

https://www.coveredca.com/coverage-basics/special-enrollment/

https://www.coveredca.com/FAQs/cobra/

https://www.coveredca.com/FAQs/cobra/

http://hbex.coveredca.com/navigator-program/

https://www.coveredca.com/faqs/Medi-Cal/


http://www.coveredca.com/faqs/prescription-drugs/




QUESTIONS & RESPONSES Submit questions using the question box

RESPONSES TO YOUR QUESTIONS FROM THE LAST WEBINAR

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Questions Answers

COMMUNITY OUTREACH NETWORK (CON) Can we educate at college fairs? Yes Can we advertise through the movie theater commercials, schools, colleges?

Yes

As grantees are we allowed to use CON members?

Yes

Will we be able to get CON partner group members into education trainings this year without going through an Enrollment Entity?

Our goal is to have our Partners have access to the Computer Based Trainings.

CON partners are not certified to enroll consumers, but is there anything to prevent them from offering some form of assistance in an unofficial capacity?

CON partners are not certified to provide in-person assistance to consumers on behalf of Covered California. They can help others at their own discretion.

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Questions Answers COMMUNITY OUTREACH NETWORK (CON)

Can you provide the names of the CON that are currently part of the CON?

Yes, you can find the current partners listed on our website here: http://hbex.coveredca.com/community-outreach-network/PDFs/CON-Partners-Contact-List.pdf

Or you can…

1. Go to CoveredCA.com. 2. Click on “Programs & Partners” at the top header tool

bar and select “Outreach and Education” from the drop down sub headings.

3. Click on the “Community Outreach Network” icon at the bottom middle of the webpage.

4. Click on the link “Partners Contact Information” at the right hand side under Community Outreach Network.

5. View the list in a PDF format. Partners are listed in alphabetical by the county where they are located.

http://hbex.coveredca.com/community-outreach-network/PDFs/CON-Partners-Contact-List.pdf











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Questions Answers PRESCRIPTION DRUG COVERAGE

Some Covered California insurers (Health-Net) insist that prescriptions be mailed to clients. It can take up to 10 days. Is this acceptable?

Covered California Health Plans offer a variety of prescription drug services. Some plans may even offer a discount for electing to participate in the prescription mail delivery service.

Mail order is not mandatory for maintenance drugs. Health Net’s incentive for using mail order is getting a 90-day supply of the drugs at only twice the retail (30-day) copay.

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Questions Answers PREGNANCY COVERAGE

The pregnant women can apply for Medi-Cal through the Covered California website correct?

Yes, pregnant women can apply for Medi-Cal through Covered California.

Do they apply for AIM as well through Covered California website like Medi-Cal?

At this time those eligible for the AIM program should apply at www.aim.ca.gov at (800) 433-2611.

Is pregnancy considered a special enrollment qualifying event?

No, pregnancy is not a Qualifying Life Event. The actual birth of the child is considered an addition to the household and the Qualifying Life Event that would trigger a special enrollment for the household. Consumers may contact the Service Center to report this Qualifying Life Event ahead of the birth date.

The presumptive eligibility time is no longer 2 months. It is now up to the expected delivery date?

This is incorrect. The Presumptive Eligibility (PE) period lasts up to 60 days, beginning the first day of the month the PE application is approved, and ending the last day of the following month.

Pregnant women with other children are already eligible up to 138% - SB857 allows women who are pregnant at time of application without other children in the home to access full scope Medi-Cal coverage up to 138?

The intended purpose of SB 857 is to align a variety of pregnancy-related Medi-Cal programs to the 138% FPL threshold.

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Questions Answers

SPECIAL ENROLLMENT / QUALIFYING EVENTS Why the July 15 end date for COBRA enrollment?

May 15th - July 15th was the special enrollment period given for consumers who were not aware of their options on CoveredCA.com and elected to have COBRA benefits. These consumers are able to cancel their COBRA coverage without having exhausted the benefits. After July 15th, COBRA enrollees will have to wait until the next open enrollment, or until COBRA benefits expire in order to enroll into a Covered California Health Plan.

What is the time frame for a consumer that has experienced a qualifying life event to be able to pick a qualified health plan?

Consumers have 60 days from the date of the Qualifying Life Event to complete a special enrollment. Consumers can also notify Covered California up to 60 days prior, if they know the date of their upcoming qualifying life event.

If a consumer enrolled in Anthem in April 2014 and then in November they select Kaiser, when will the change take place?

Consumers that choose to switch health insurance companies in the next open enrollment will see these changes take effect in the new plan year - 1/1/2015.

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Questions Answers SPECIAL ENROLLMENT / QUALIFYING EVENTS

If the consumer declines COBRA, what happens next? Does the consumer enrollment application occur through Covered California?

Yes, consumers who opt out of COBRA should instead apply on CoveredCA.com.

Upon the birth of a child, is the whole family eligible for special enrollment with Covered California?

The addition of a new member of the household triggers special enrollment for the entire household which would allow the family to switch their health plan or company if they chose to do so.

When submitting a special enrollment application, how long will it take for the applicant to get a response?

Eligibility determinations are immediate upon submission of the application for any special enrollment that does not fall under the “Other” category for a Qualifying Life Event. The “other” event will be reviewed by Covered California within 10 business days from submission.

Which qualifying event applies to the full household and which apply to an individual?

Please refer to the Community Partner webinar from 6/18 for more information about Special Enrollment and Qualifying Life Events.

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Questions Answers

CEE PAYMENTS How do we check to see if our CEE is eligible for compensation for enrollment assistance?

Please email [email protected] to inquire about the status of your entity’s payment eligibility.

Can we have a notation added to the pay warrant to distinguish payment for Medi-Cal and Covered California applications?

Pay warrants were sent separately for Covered California and Medi-Cal assisted applications. Please refer to the letter attached to each warrant.

Is there a place on the IPAS where we can look at the status of our applications once we have applied to become a Certified Enrollment Entity (CEE)?

For inquiries in regards to the application to participate as a CEE/CEC please login to IPAS and review the Entity Status Data Board. Payment status inquiries should be directed to your Enrollment Assistance Specialist if you are a CEE.

Will we receive a payment detail list for Medi-Cal payments?

The Summary of Payments Notice (Remittance Advice) will be mailed 7/18/2014.


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Questions Answers

CEE PAYMENTS Who do we contact about obtaining payments?

If you are a CEC please contact your CEE about obtaining payments. If you are a CEE please contact your Enrollment Assistance Specialist for payment inquiries or by contacting the Enrollment Assistance Help Line at 1-855-324-3147.

Who does a CEE contact to receive payment or do they contact Covered California directly?

Please submit a Payment Reconciliation Research Request Form (PRR) in your IPAS account for applications you believe to be eligible for payment and you have not received credit yet.

How do we identify which clients we were paid for?

The Summary of Payments Notice (remittance advice) is sent separately from each check. Each Summary of Payment Notice details the applications that were credited in the check.


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Questions Answers FEDERAL POVERTY LEVEL

Where can we find the new FPL guidelines?

DHCS has posted the 2014 FPL guidelines for Medi-Cal on their website: www.dhcs.ca.gov. Per IRS and federal regulations, Covered California uses the 2013 FPL guidelines for APTC/CSR which can be found at CoveredCA.com. Covered California will use 2014 FPL guidelines during Open Enrollment for the 2015 benefit year.

Did the FPL change in April?

The 2014 FPLs for Medi-Cal were implemented in April.

Please clarify the income level for a pregnant woman. My understanding was that it is 200% FPL

There are Medi-Cal programs for pregnant women with different FPL percentages. The intent of the legislation discussed in the last webinar is to make these a uniform ceiling at 138% FPL.

Can we have a new paper calculator with the new April 1st, FPL?

Collateral material is continuously being updated in preparation for Renewals and Open Enrollment and will include updated FPLs.

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Questions Answers GENERAL QUESTIONS

Will people be able to opt out of Medi-Cal if they want to purchase a Covered California policy instead?

Consumers may opt out of Medi-Cal and purchase an unsubsidized Covered California Health Plan.

Is the CEE in-person assister program going to continue or be canceled?

The IPA Program will continue through the next Open Enrollment for the 2015 benefit year.

Are you still planning to add updated materials in the print store within the next week or two for O&E grantees?

Collateral materials will be updated and made available on an ongoing basis.

Is it correct to say that one cannot sign up for expanded MAGI Medi-Cal under Covered California if one is on Medi-Care?

Please refer to our FAQs on Medicare: http://www.coveredca.com/faqs/Medicare/.

Is the only way to get Medi-Cal through a county office?

No, consumers may apply for Medi-Cal through CoveredCA.com as well.

http://www.coveredca.com/faqs/Medicare/

http://www.coveredca.com/faqs/Medicare/

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THE PRESENTATION PORTION OF THIS WEBINAR HAS CONCLUDED

YOU MAY CONTINUE TO SUBMIT

QUESTIONS VIA THE QUESTION BOX

COVEREDCA.COM RESOURCES

Documents

Community Partner Webinar July 2, 2014