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JOB AID: RENEWAL
CoveredCA.com is a joint initiative between Covered California and the California Department of Health Care Services Page 1 of 13
October 7, 2015
2016 Covered California Renewal
Covered California’s renewal period (annual redetermination process), October 12 through
December 15, 2015, is intended to help Individuals and Families retain health coverage for
2016. This Job Aid is for Service Center Representatives, County Eligibility Workers, Plan-
Based Enrollers, Certified Enrollment Counselors, and Certified Insurance Agents who are
assisting consumers to complete their renewal, and illustrates the functionality from the
consumer’s perspective.
Who Is Qualified for Renewal?
As part of annual renewal, eligibility will be re-determined for subsidized and unsubsidized
households that are enrolled in a plan and have made their first premium payment (i.e.,
effectuated) or pending (enrolled in a plan with pending effectuation). Households are selected
for renewal if they provided consent for verification for the upcoming coverage year. Notices will
be sent to qualifying households to notify them of their opportunity to update information and
confirm plan choices for the upcoming year. Note: APTC households who do not provide
consent for verification are auto-renewed into an unsubsidized plan (income verification is not
required).
Households Not Eligible For Renewal
Applications which were withdrawn or terminated
Cases which opted out of renewal during the renewal timeframe (between the dates of
October 12 and December 15, 2015)
For Households who are not eligible for Renewal, the Apply Now button displays on the
Individual Landing page instead of the Continue button:
JOB AID: RENEWAL
Your destination for affordable,
quality health care, including Medi-Cal
JOB AID: RENEWAL
CoveredCA.com is a joint initiative between Covered California and the California Department of Health Care Services Page 2 of 13
Renew Mode
A household in Renew mode displays an Individual Landing page with the message: It’s time to
renew your coverage. One of three program-specific Renewal sections displays, along with
instructions on how to continue coverage for the next benefit year.
Depending on the program-specific Renewal section displaying, clicking the Continue button
navigates the Consumer to a page to confirm their household information:
California Renewal - navigates the user to the Renewal Summary page
Mixed Household Renewal - navigates the user to the Renewal Summary page
Medi-Cal Renewal – navigates the user to the Report a Change Summary page
JOB AID: RENEWAL
CoveredCA.com is a joint initiative between Covered California and the California Department of Health Care Services Page 3 of 13
Some important points about Renewals:
The Preview and Apply tabs in the global header are inactive until the renewal is
complete.
If the renewal has already been initiated but eligibility has not been finalized, the
Renewal Summary page (or Report a Change Summary page for Medi-Cal Renewal)
displays to allow the Consumer to resume progress. The Consumer can continue to
review and submit their information to complete the renewal.
If eligibility has been finalized but plan selection has not been confirmed, the Household
Enrollment Introduction page displays. The Consumer can continue to confirm plans for
2016.
If the renewal was initiated by SAWS and plan selection is complete, the following text
displays instead: “Your case is under review, please contact your county worker for
further information.”
Renew Mode Page - Opt In/Out
An Admin user (Service Center Representative or County Eligibility Worker) has the functional
option to move a case out of Renew mode (exempt it), and then back into Renew mode, if a
process or policy should warrant this action.
Note: If a household has completed the renewal process for the upcoming year, access to the
Renew Mode page is not available.
1. From the Search Individual page, enter search
criteria to locate the consumer, and then click the
corresponding radio button from the results list.
Click the Manual Verification button. The
Household Verifications page displays.
2. Click the Renew Mode tab from the left-hand
Verification panel. The Renew Mode page
displays.
Exempt Case from Renewal
3. Select the Off value from the dropdown
and then click the Update button.
4. An Opt-in / Opt-out Confirmation
popup displays stating: Your update
has been successfully saved.
5. Click the Ok button. The Individual
Landing page reflects the consumer is
no longer in Renew mode.
JOB AID: RENEWAL
CoveredCA.com is a joint initiative between Covered California and the California Department of Health Care Services Page 4 of 13
Repeat the above steps to move the
consumer back into Renew mode—only
this time, select the On value.
The following content gives an overview of
a Covered California Renewal.
Renewal Summary Page
The Renewal Summary page displays 2015 household information. Each section should be
reviewed to confirm it is correct for the upcoming coverage year. Once the information is
submitted, it is used to determine
eligibility for 2016.
1. Review all the information
displayed on the Renewal
Summary page.
If there is new information for
2016, click the Edit button in the
section that needs updating and
enter the new information.
To add a household member, for
example, click the Add
Household Member button at
the bottom of the Renewal
Summary page and complete
the pages required.
If there is no new information
for 2016, click the Continue
button at the bottom of the
Renewal Summary page to
proceed to the Signature for
Renewal page to sign and
submit the consumer’s
renewal application.
Note that information entered
during the renewal applies to
the upcoming coverage year
and may impact eligibility for
insurance affordability
programs as of January 1,
2016.
JOB AID: RENEWAL
CoveredCA.com is a joint initiative between Covered California and the California Department of Health Care Services Page 5 of 13
Examples of the types of changes that may impact eligibility include:
Change of physical Address
Change in Household Income
Add or Remove a Household Member
2. When all household information for the upcoming coverage year is confirmed, click the Continue button at the bottom of the Renewal Summary page.
Voter Registration
The Voter Registration page displays
allowing the consumer an opportunity to
register to vote. After selecting an option,
click the Continue button. The Signature
for Renewal page displays.
Signature for Renewal
3. The Signature for Renewal page
displays. On the Signature for
Renewal page, review any changes in
the Your Changes section.
Each type of change has a
corresponding dropdown list for the
change Reason with
options unique to the
Type of Change. Select
the appropriate option,
and then enter the Event
Date. If there are no
changes, the section is
blank as shown. The
Cancel all changes link
displays only if changes
are detected.
JOB AID: RENEWAL
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4. Attest to the statement, “I know that I must report any changes to information on this
application”, under the Your Changes section by clicking the checkbox.
5. Click the Declaration
checkbox in the Review and
Sign section. Note that the
Submit button at the bottom
of the page is disabled until
all checkboxes on the
Signature for Renewal
page are checked.
6. The Consumer enters their
Electronic Signature and
Electronic PIN number to
sign the renewal. Click the
Submit button at the bottom
of the page to submit the
renewal application and
initiate the eligibility
determination.
Note: The Review and Sign
section does not display for
the Service Center
Representative or County
Eligibility Worker.
JOB AID: RENEWAL
CoveredCA.com is a joint initiative between Covered California and the California Department of Health Care Services Page 7 of 13
Renewal Results
The Renewal Results page
displays a summary of health
care programs the household
is eligible for in the upcoming
coverage year.
Carefully review the eligibility
information on this page with
the Consumer. The household
may be eligible for different
programs or required to
provide documentation to
ensure the household obtains
or retains coverage for 2016
that is appropriate for their
eligibility.
To view a PDF version of the submitted renewal application, click the Submitted Application
button at the bottom of the Renewal Results page.
To save your
information and exit
the renewal, click
the Save & Exit
button. You will be
navigated to the
Individual Landing
page.
7. Click the
Choose Health
Plan button on
the Renewal
Results page to
navigate to the
Health
Enrollment
Introduction
page to confirm
or change plan
choice for 2016.
JOB AID: RENEWAL
CoveredCA.com is a joint initiative between Covered California and the California Department of Health Care Services Page 8 of 13
Note: The Choose Health Plan button does not display on the Renewal Results page for
all eligibility situations. For example, for Medi-Cal eligible cases, the following text displays
instead: “If you or members of your family end up being eligible for Medi-Cal coverage, your
county human services agency will contact you.”
Renew Health Plans
The Household Enrollment Introduction page displays the health programs for which the
household members are eligible. For Covered California plans, eligible Consumers have the
option to keep their current plan or shop for a new one.
Covered California Plan Auto-Enrollment
Covered California will automatically enroll eligible household members in their current plan or
similar plan if the Consumer does not select a new plan by the date displayed on the Household
Enrollment Introduction page.
Health insurance carriers will notify consumers of a 2016 plan substitution to a similar plan if
their 2015 plan is no longer available. If the current plan is not available for 2016, the Consumer
must take action and select a new plan no later than December 15, 2015 to prevent a break in
coverage. (Note: The health insurance carrier will provide notice to the Individual if a plan will
not be available in the upcoming coverage year.)
In most cases, if the consumer does not select a plan by the date shown on the Household
Enrollment Introduction page, Covered California auto-enrolls them in the same plan for the
upcoming benefit year.
JOB AID: RENEWAL
CoveredCA.com is a joint initiative between Covered California and the California Department of Health Care Services Page 9 of 13
Choose a Health Plan for 2016
8. Click the Choose Health Plan button on the Household Enrollment Introduction page to
review and confirm plan or make a new plan choice. The Getting Started page appears.
The Getting Started page allows the Consumer to review their current plan information, and
keep their current plan or select a new plan for coverage effective January 1, 2016.
Consumers should review the details
of their plan carefully as the premium
rates, plan network or coverage
details might have changed for 2016.
It is also possible that the amount of
the 2016 Premium Tax Credit is
different from the amount received
for 2015. To keep the existing plan,
click the Keep button.
To shop for a new plan for 2016, click
the Shop button on the Getting
Started page.
JOB AID: RENEWAL
CoveredCA.com is a joint initiative between Covered California and the California Department of Health Care Services Page 10 of 13
Select a New Plan for 2016
The Getting Started page welcomes the Consumer to the Plan Selection process. Click Next to
navigate to the Browse Plans page.
The Browse plans page
allows the Consumer to
browse and compare their
2015 plan to those
available for 2016. From
this page, the Consumer
can shop for a new plan or
add their existing plan to
their cart. The first plan
displayed on the Browse
plans page is the same or
the most like their 2015
plan. Click the Add button
to add the plan to Your
Cart to confirm the plan
choice for 2016.
When plan selection for
2016 has been confirmed,
the Provide eSignature
page displays. Review the information on the Provide eSignature page with the Consumer.
The consumer attests to the statement, “I agree to file a (2016) tax return before (April 15,
2017) to claim the Premium Tax Credit,” by clicking on the adjacent checkbox.
JOB AID: RENEWAL
CoveredCA.com is a joint initiative between Covered California and the California Department of Health Care Services Page 11 of 13
Select the I Have Read and
Agree to the Binding
Arbitration Agreement
checkbox. The Consumer
then enters their PIN in the
Pin Number field and types
their full name in the
eSignature field.
Click the Enroll button at the
bottom of the page to continue.
The Confirmation page displays the new plan for coverage effective January 1, 2016. Click the
Continue button at the bottom of the page to review the household’s plan enrollment.
JOB AID: RENEWAL
CoveredCA.com is a joint initiative between Covered California and the California Department of Health Care Services Page 12 of 13
Dental Coverage
Continue the enrollment process by
selecting or opting out of dental
coverage. Family dental plan
selection is offered to a household
with at least one adult member
enrolled in a Covered California
Plan. Note: Children’s dental
coverage is embedded in their
health plan.
Household Enrollment
Summary
The Household
Enrollment Summary
page provides information
about the household’s
enrollments, including the
initial payment due date.
Click the How to Pay link
to view details on how to
make payments directly to
the health insurance plan.
View plan enrollment information by coverage year on the Household Enrollment Summary
page. Select from the Viewing Enrollment Information for dropdown to view plans by
coverage year.
JOB AID: RENEWAL
CoveredCA.com is a joint initiative between Covered California and the California Department of Health Care Services Page 13 of 13
Click the Take Survey button to navigate to a Covered California survey to provide feedback on
the Consumer experience. Click the View Additional Programs button to navigate to the
Additional Programs page. Click the Done button to return to the Individual Landing page.
Note: Consumers may change their medical plan and/or dental plan choice made in Renewal
during the Open Enrollment period for the upcoming coverage year by clicking the Change Plan
link in the Actions section on the Individual Landing page.
Auto Enrollment
Auto-enrollment is a batch process that automatically re-enrolls an eligible household in the
same plan for the upcoming coverage year if they have not confirmed their current plan or
selected a new plan by the due date indicated on the Health Enrollment Summary page. The
last batch run for auto-enrollment will occur 12/13/15 through to 12/15/15 to enroll with an
effective date of 1/1/2016.
Note the following cases are not eligible for auto-renewal:
MAGI Medi-Cal only cases
Cases terminated before October 12, 2015
Cases enrolled with a Special Enrollment event after October 12, 2015