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JOB AID: APPLICATION OVERVIEW

January 9, 2015

This Job Aid provides an overview of the application pages in CalHEERS from the Certified Enrollment Counselor and Plan Based Enroller perspective and highlights the pages a CEC or PBE will fill out for an applicant applying for 2015 benefits. The Job Aid is not intended to detail functionality of each application page as existing Job Aids provide this level of specificity.

Note, a PBE has the same access as a CEC.

CEC Dashboard

1. From the Dashboard page, click Add

New Individual below Quick Links.

Note: CECs may apply for individuals

who have sent a help request. Click

the Pending Requests link below

Quick Links to display the Pending

Individuals List, and use the Actions

icon ( ) to activate the Individual.

The Individual now displays on the

Active list. To start or resume the

application, click the Individual’s name

link to view their profile, then click

Switch to Individual View.

2. Click Apply Now to initiate the

application. (If an applicant had

begun their application before

sending a help request, the CEC

would click Resume).

Apply Start

3. Click Continue on the Overview page.

Your destination for affordable,

quality health care, including Medi-Cal

Your destination for affordable,

quality health care, including Medi-Cal



4. The Apply for Benefits page collects

basic information about the type of

application, number of household

members, application date, and

source of the application. Click

Continue to navigate to the Consent

for Verification page.

5. The consumer must agree to

Consent for Verification to proceed

with the application. After checking

the box, click the Continue button to

navigate to the Household data

collection pages.

Household Information

6. Click Continue on the Household

Introduction page to begin collecting

information for the Primary Contact.

7. On the Household Primary Contact

page, the applicant indicates a

method to verify their identity. If the

applicant provides electronic

documentation that verifies their

identity:

Click Yes for I attest that I have visually verified this person’s identity.

Click Upload Documents and select the documents you’ve received from the applicant

If the applicant chooses to verify

through Experian via the Federal

Hub:

Click No for I attest that I have visually verified this person’s identity.

Click Yes for I have the consumer’s consent to access…Remote ID Proofing Service

Note: If the applicant elects not to provide either option for verifying their identity, they will not be able

to proceed with the application electronically. They can submit a paper application, in which their

physical signature serves as proof of their identity.



8. Continue with completing the

sections on the page. Enter the

applicant’s legal first and last name,

their date of birth and social security

number if they have one. Enter their

contact information, including phone

number(s) and email address. In the

Primary Contact – Home Address

section, enter the applicant’s

physical address. This is important

for determining the correct plans for

the household. Enter a mailing

address if different from the physical

address. Select the applicant’s

preferred method of communication.

When completed, click Continue.

9. An address confirmation window displays

indicating if the address is valid, or if a

close match exists. If a match cannot be

found, the user can either click Cancel

and correct the address entered or click

the radio button next to the address to be

used for the household, and click Ok to

continue.

10. If the applicant chose to use the Federal

Hub to validate their identity, answer the

questions on the Confirm Identity page.

Click Continue to begin entering

household member information.



11. Complete the Household Members

page for all members of the

household. Enter their names, date

of births, and social security numbers

(if they have one) or alien residency

designation if applicable.

Note:

Be sure to click Yes for Does this

person want health insurance?

This will include the household

member in the eligibility

determination and plans offered

for the family.

The social security fields and

residency questions are dynamic,

meaning the page will change

depending on what radio button is

selected for a question. Complete

all fields on the page.

The button Add Another Member should only be used if the applicant did not identify the

correct number of members on the Apply for Benefits page (step 4 above). Use the Continue

button to enter information for the next household member.

12. Once all household member

information has been entered,

complete the Relationships page. Fill

in the correct relationship for each

member. When done, click Continue

to review.



13. Review the Household Summary page

for accuracy, verifying date of birth and

relationships for each person. Click

Continue to proceed to the Personal

Data section.

Personal Data

14. Click Continue on the Personal Data

Introduction page.

15. Complete the Address & Contact page.

Enter additional contact information for

household members if available. When

complete, click the Continue button to

navigate to the Personal Data –

Demographic Information page.



16. Complete the Personal Data –

Demographic Information page for

each household member. Note,

questions display differently

according to whether the household

member is female, male, or child:

If a female is pregnant, two fields

display dynamically requesting

the expected delivery date and

number of children expected.

Indicate the primary caretaker for

a child.

Click Continue when complete to

navigate to the Personal Data – Tax

Information page.

17. Fill out the Personal Data – Tax

Information page for each household

member. There can only be one

primary tax filer in the household.

Custodial information and a contact

number if the custodial parent is in

the home is required for each child.

When complete, click Continue to

navigate to the Health Care

Information page.



18. On the Health Care Information

page, indicate if anyone has or has

been offered affordable, minimum

standard value health insurance for

the benefit year. Answer questions

for each household member. Click

Continue to navigate to the Optional

Data page.

19. Complete the Optional Data page for

each household member. This

information is not required to

determine eligibility for the household, nor

is it required to complete the application.

Click Continue to navigate to the Personal

Data Summary page. Refer to policy

guidelines for instructions on completing

this section of the application.

20. Review each section on the Personal Data

Summary page for each household

member. Click the Edit button to make

changes to a particular section, or click

Continue to navigate to the household

income collection sections.

Household Income

21. Click Continue on the Income

Introduction page to navigate to the

income collection pages. There



are three income pages and one

income deduction page.

22. Enter income on the

Employment Income, Self-

Employment Income, and/or

Other Income pages. Click Add

Income to add a source of

income or a different amount of

income. Click the Edit link to edit

an income record, such as adding

a Last Date Paid for income that

has ended or is changing.

23. On the Add Income page, enter the

employer or income source, the

amount of income, and the frequency

the income is paid. The First Date

Paid field indicates the first date this

individual received a check from this

source at this rate. The Last Date

Paid field is populated when an income

has ended or the rate has changed.

Note, income that does not have a Last

Date Paid will be applied towards their

2015 annual income.

24. Complete the remaining income sections

for all household members who collect

income or have deductions by clicking

Continue. Self-Employment must be

submitted as a monthly income, and should

include net expenses, less cost.

A one-time Lump Sum is entered on

the Other Income page, do not include

income if received for more than one

month. Deductions entered on the

Income Deductions page reduce the

household’s modified adjusted gross

income.

25. On the Income Summary page,

carefully review the current monthly

and total adjusted annual income.

Note, the Total Projected Annual

Household Income reflects the

amount for the current calendar year,



not necessarily the benefit year. Click Continue to review the application.

Eligibility

26. Prior to determining eligibility for the

household, the Submit Application

for Eligibility allows the applicant to

review the entire application for

accuracy. Click Edit to make

modifications to a section of the

application or Continue to proceed.

27. The Voter Registration page displays

next and allows an applicant to

register to vote if they are currently

not registered. Registration is not

mandatory and has no effect on

eligibility or any potential assistance

offered to the household. Click

Continue to verify with an electronic

signature that all information in the

application is true and correct, and

attest to report as required any

changes to information provided on

the application.

28. On the Application Signature Page, indicate the

length of time the applicant will allow Covered

California to use tax returns to determine

eligibility. The applicant can choose from 5 to

0 years from the Maintain My Consent for

dropdown. Review and attest to the

statements in the Review and Sign section by

selecting the checkbox. Once checked, enter

your Electronic Signature and Pin in the

applicable fields. When all fields are populated,

the Submit button will become enabled. Click

Submit to determine eligibility for the

household.

Note: If you are completing the application on

behalf of the consumer, you will see a popup

containing an Access Code. The applicant can use this

later to associate their case to their Covered California

account.



29. Review the Eligibility Results page

for each household member. The

household will be evaluated for

Covered California Plans, Premium

Assistance Plan, Cost Sharing

Reduction Plans, and MAGI Medi-

Cal, based on reported annual

income (or monthly income for MAGI

Medi-Cal). Eligibility results may

display as conditional when

additional documentation is required

to verify eligibility. Applicants will

have 90 days to provide the

additional documentation if they are

deemed conditionally eligible. An

eligibility determination will not enroll

applicants into a Covered California

Plan, unless MAGI Medi-Cal eligible.

Click Choose a Health Plan to

navigate to the Plan Enrollment

section for plan selection.

Enrollment

30. The Household Enrollment

Introduction page displays members

of the household who qualify for plan

selection through Covered

California. Click Choose Health

Plan to begin shopping for health

plans.

31. On the Shop for Health Plans page,

click Next to navigate to the Find a

Plan page where consumers can

indicate the number of office visits

and medication use estimates for CalHEERS

to offer plans that best fit the household’s

needs.



32. Next indicate the expected medical and

prescription use for each eligible member in

the household. This is not mandatory nor

does it affect the cost of a plan. Answering

these questions arranges plans in an order

for the consumer that predicts the lowest

annual out of pocket expenses. Click

Choose a plan to continue.

33. Scroll through the plans offered to the

household. Plans can be filtered, marked as

favorites and compared, and added to the

consumer’s cart. The lower section of the

page displays additional information about

plans for comparison and estimating annual

costs. Once a plan has been added to the

cart, a popup will display

with the plan type, and the

View Cart button. Click

View Cart to view selected

plans.

34. The Your Cart page

displays the selected plan,

monthly costs, and the

monthly payment based on any Premium

Assistance applied. The consumer can adjust

the amount of Premium Assistance applied by

clicking the Adjust button, and clicking 3 from

the Premium Assistance popup.

35. Once both the plan and Premium Assistance

adjustments have been completed, click

Checkout to confirm.



36. On the Provide eSignature page,

click the checkbox that states the

consumer consents to filing a tax

return, and the checkbox indicating

the consumer has read the Binding

Arbitration Agreement. Enter your

electronic PIN and your signature.

Click Enroll to enroll the consumer’s

household in the selected Covered

California Plan.

37. A Confirmation page displays. Click

Continue to navigate to the

Enrollment Summary page.

38. The Household Enrollment

Summary page displays detailing how

the consumer can pay their initial

Premium Payment. Some plans allow

the initial payment to be made through

Covered California. In this case, a

Pay Now button will display under the

Initial Payment column. All future

payments will have to be paid either

through the mail or the plan’s website.

If the Pay Now button does not

display, the plan selected does not offer

initial payment through Covered

California and the consumer will have

to make their first and ongoing payment

by mail or via the plan’s website.