Assisting Consumers With Redeterminations And Re-enrollments PDF

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Assisting Consumers withRedeterminations and Re-enrollmentsOctober 11, 2018Centers for Medicare & MedicaidServices (CMS)Center for Consumer Information& Insurance Oversight (CCIIO)

DisclaimerThe information provided in this presentation is intended only as a general informalsummary of technical legal standards. It is not intended to take the place of the statutes,regulations, and formal policy guidance that it is based upon. This presentationsummarizes current policy and operations as of the date it was presented. Links tocertain source documents have been provided for your reference. We encourage learnersto refer to the applicable statutes, regulations, and other interpretive materials forcomplete and current information about the requirements that apply to them.This document generally is not intended for use in the State-based Marketplaces that donot use for eligibility and enrollment. Please review the guidance on ourAgents and Brokers Resources webpage ( to learn more.Unless indicated otherwise, the general references to “Marketplace” in the presentationonly includes Federally-facilitated Marketplaces (FFMs) and State-based Marketplaceson the Federal Platform.This communication was printed, published, or produced and disseminated at U.S.taxpayer expense.1

Webinar Agenda Batch Auto Re-enrollment (BAR) RefresherWhere Consumers Review and Update Their 2019 ApplicationsHow Consumers Can Stop Coverage for 2019 (Opt Out of BAR)How to Ensure You Get Credit for Assisting with AnnualRe-enrollmentsWhere to Insert Your National Producer Number (NPN) ApplicationsAvailability of Help On DemandHelp Desk and Call Center Support, Resources, and Key RemindersQuestions and Answers2

Assisting Consumers withRedeterminations and Re-enrollmentsBatch AutoRe-enrollmentRefresher3

No Changes to BAR for 2019 Each year, Marketplaces mustredetermine the eligibility ofconsumers enrolled in coveragethrough the Marketplace.The process for plan year 2019 isthe same process used for planyear 2018, as described in thepublished “Guidance on AnnualEligibility Redetermination andRe-enrollment for ExchangeCoverage for 2019 and Later Years.”4

BAR Refresher To provide issuers enough time to ensure a smooth consumer reenrollment experience, the Marketplace sends redetermined financialassistance data to issuers via re-enrollment transactions in October formost re-enrollees.For an enrollee who does not contact the Marketplace to obtain anupdated eligibility determination and select a qualified health plan(QHP) by December 15, 2018, the Marketplace will establish 2019eligibility for advance payments of the premium tax credit(APTC) and cost-sharing reductions (CSRs) based on the mostrecent household income data available, together with updatedfederal poverty level (FPL) tables and benchmark plan premiuminformation.The Marketplace will re-enroll the enrollee effective January 1, 2019 inthe same or a similar QHP, in accordance with 45 CFR 155.335(j).5

What is BAR? Auto re-enrollment, also referred to as Batch Auto Re-enrollment, or BAR, isthe process the Marketplace uses to ensure that current enrollees who do notmake an active plan selection by December 15, 2018 (the close of the plan year2019 Open Enrollment period) can have coverage on January 1, 2019.Active re-enrollment, where an applicant updates the application and planselection, is always preferred.– Active re-enrollment ensures the enrollee receives a more accuratefinancial assistance eligibility determination and that the re-enrollmentQHP reflects qualities that are important to the enrollee (e.g., cost,provider network, prescription drug formulary).– Some enrollees will lose their financial assistance unless they activelyre-enroll. The Marketplace Open Enrollment Notice (MOEN) sent to themby the Marketplace will include special language noting the need toactively apply.6

Auto Re-enrollment Frequency Auto re-enrollment will run in two rounds:1. Round 1 October 15 (approximate): All enrollees eligible for renewal who arere-enrolled in a QHP offered by the same issuer or matched to an alternateQHP from a different issuer by CMS or a state Department of Insurance(DOI). Goal is to complete this round by November 1.2. Round 2 December 16: New 2018 enrollees who enrolled after Round 1;enrollees whose auto re-enrollment is updated because the enrollee reported,or the Marketplace otherwise obtained, new eligibility information after theOctober BAR. Pre-populated 2019 applications will be available to consumers with priorMarketplace applications beginning in November; consumers can access the prepopulated application by logging into their existing Marketplace accounts.Note: The auto-re-enrollment plan is not visible in consumers’ accounts untilDecember 16; however, enrollees can find their BAR plan highlighted in PlanResults after submitting an application during the Open Enrollment period.7

Knowledge CheckThe Marketplace will establish consumers’ 2019 eligibilityfor APTC and CSRs based on the following:A) Most recent household income data availableB) Updated FPL tablesC) Benchmark plan premium informationD) All of the above8

Knowledge CheckThe Marketplace will establish consumers’ 2019 eligibility forAPTC and CSRs based on the following:A) Most recent household income data available,B) Updated FPL tablesC) Benchmark plan premium informationD) All of the above9

Marketplace Open Enrollment NoticeThe MOEN alerts enrollees about the start of plan year 2019 Open Enrollmentperiod. CMS will provide all MOENs toconsumers by November 1, 2018.The MOEN welcomes currentenrollees back to the Marketplacefor Open Enrollment, provides acall to action for people who are atrisk of losing eligibility for APTCand CSRs, and complements issuernotices.10

Marketplace Open Enrollment Notice (Continued) The MOENs for specific groups of consumers who are at risk for losingeligibility for APTC on December 31 (e.g., opt-out, special notice group,repeat passive enrollments, and failure to reconcile) will containadditional content with information tailored to their group.The MOEN will direct these consumers to update their applications toensure the Marketplace has the most accurate information available toredetermine their APTC eligibility for the future year.The MOEN does not contain financial assistance amounts, nor does itidentify the re-enrollment plan; that information comes from theissuer’s notice (or the 2019 issuer in the case of alternate enrollments).11

Knowledge CheckThe Marketplace Open Enrollment Notice contains all of the following,except:A. Financial assistance amountsB. An opt-out optionC. A call to action for people who are at risk of losing eligibility forAPTCD. All of the above12

Knowledge CheckThe Marketplace Open Enrollment Notice contains all of the following,except:A. Financial assistance amountsB. An opt-out optionC. A call to action for people who are at risk of losing eligibility forAPTCD. All of the above13

Auto Re-enrollment ProcessStep 1: CMSselectsapplications withcurrentenrollment.Step 4: CMS sendsthe enrollmenttransaction to theissuer.Step 2: CMS prepopulates a plan year2019 application inthe background. Theapplication is notvisible to theconsumer untilNovember 1.CMS repeatssteps 1-4 forRound 2applications,Step 3: CMS creates a planyear 2019 enrollment usingplan crosswalk provided bythe issuer, or an alternate planfrom a different issuer. Thisenrollment is not visible tothe consumer until December16 and only if the consumerdoes not select a plan by then.Step 5: CMS generates anEligibility DeterminationNotice (EDN) and enrollmentconfirmation message forconsumers who do not make anactive selection by December15. This step does not occuruntil late December/earlyJanuary.14

Auto Re-enrollment for Enrollees with aDiscontinued Plan (Alternate Enrollment) BAR will occur for most enrollees whose current issuer has no reenrollment QHP option available to them.The applicable state authority (e.g., DOI) or CMS will select analternate QHP from a different issuer.The enrollee will receive:– A discontinuation notice from the old issuer (by November 1)– A notice and emails from his/her Marketplace encouraging activeselection and enrollment in a new plan (by November 1)– An acknowledgment of the pending enrollment from the newDOI/CMS-selected plan issuer (January binder bill will be sentafter November 1.)The enrollee must make the first premium payment to effectuateenrollment (in contrast to same-issuer auto-renewals, where a binderpayment is not required).15

Messages for Discontinued Enrollees Matched toAn Alternate PlanEmphasize the December 15 Open Enrollment deadline and encourage activechoice in selecting a new plan (whether it is the alternate or something else thatbetter meets their needs).If you don’t act, you may be automatically enrolled inX plan. Don’t wait—contact us to review this plan andother options before December 15 and choose whatworks best for you.We know your plan is no longeravailable to you. We’re here tohelp. You’ve been matched withX plan.Update your application withthe Marketplace and say you’relosing coverage December 31.You can then confirm thisalternate plan or choose a newone.If you like the alternate plan theMarketplace has matched youwith, be sure to pay thepremium bill this insurancecompany sends you.Contact us and we’ll helpyou review and find theplan that’s right for you.Let’s check yourdoctors, benefits, andcoverage.16

Auto Re-enrolled Consumer EDNs Consumers who are auto re-enrolled by the Marketplace receive anEDN after December 15.Consumers who are auto re-enrolled in plan year 2019 coverage will seethe household income that the Marketplace used to redetermine theireligibility in the results box in the notice.As a reminder, enrollees who actively apply will receive an EDN uponsubmitting the application and never see the BAR EDN.17

Assisting Consumers withRedeterminations and Re-enrollmentsWhereConsumersReview andUpdate Their 2019Applications18

Accessing a Pre-populated Application Pre-populated 2019 applications will be available to consumers withprior Marketplace applications beginning in November.Consumers can access the pre-populated application by logging intotheir existing Marketplace accounts.Reminder: It is important to use an enrollee’s existing account to reenroll to avoid creating a duplicate enrollment.19

Accessing a Pre-populated Application (Continued)Select Update My Application to begin reviewing and editing theenrollee’s pre-populated application.20

Assisting Consumers withRedeterminations and Re-enrollmentsHow ConsumersCan StopCoverage for 2019(Opt Out of BAR)21

Extended Opportunity to Opt Out of BAREnrollees have until December 31 to tell the Marketplace that they do notwant to be auto re-enrolled.– Selecting Stop Coverage for 2019 will send a 2018 terminationthat day, with a termination date of 12/31/18.– Simultaneously, the 2019 BAR policy, if already sent, will becancelled.Don’t want your current coverage to continue into 2019?You can choose to end all of your Marketplace coverage on 12/31/18. If you do this,we won’t automatically enroll you in coverage next year.STOP COVERAGE FOR 201922

Extended Opportunity to Opt Out of BAR(Continued)You’ve chosen to stop your Marketplace coverage for 2019xYour Marketplace coverage in these plans will end on 12/31/18. HealthKeepers, Inc.(Anthem BCBS) Anthem HealthKeepers Bronze X6350FMLoadTest0946 Select Plan BasicWe won’t automatically enroll you in coverage next year. If you want Marketplace coveragein 2019, you’ll need to complete an application during Open Enrollment.GO BACKSTOP COVERAGE FOR 201923

Auto Re-enrollment Active Plan UserInterface Active 2019 plan selections throughDecember 15 automatically cancel any autore-enrollment already sent to the enrollee. 2018 enrollment updates after Round 1 BAR Marketplacewill be carried forward to the 2019 BARAccount - Mypolicy in the Round 2 BAR.Plans andIf an enrollee has not yet been included in Programsthe BAR process and makes an active planPlan Resultsselection, CMS will not complete BAR forafterthat enrollee; likewise, if an enrollee makessubmittingan update to the BAR policy, subsequentQHP-eligible2018 updates will not be carried forward toapplicationthe 2019 policy in the Round 2 BAR.(regularAbsent a special enrollment period, activesame-issuerplan selections cease December 15.BAR) November 1 –December 15December16 Not VisibleVisibleDisplayed as“Your CurrentPlan” at top ofplan resultsDisplayed as“Your CurrentPlan” at top ofplan results24

Assisting Consumers withRedeterminations and Re-enrollmentsHow to Ensure You GetCredit for Assistingwith AnnualRe-enrollments25

Get Credit for Assisting with Re-enrollments Having your NPN on your clients’ Marketplace re-enrollmentapplications will ensure issuers can identify you as assisting consumerswith re-enrollments in order to pay commissions.The following slides will review instructions for ensuring your NPN isincluded on the re-enrollment transaction for various enrollmentscenarios, including:– Active re-enrollment via the Marketplace Pathway (– Active re-enrollment via the Classic Private Partner WebsitePathway– Active re-enrollment via the Marketplace Call Center– Passive re-enrollment via BAR26

Active Re-enrollment via the Marketplace Pathway( Ensure Your NPN is on the Client’sApplication Your client should log in to his or herexisting account toaccess the pre-populated application forplan year 2019.Your client should then select theReport a Life Change option to updatethe client’s eligibility information andplan selection for plan year 2019.Your name and NPN should be enteredor updated on a client’s re-enrollment.When prompted, indicate that you provided assistance. This action will ensureyour information will persist on the enrollment transaction.Note: Remind your clients to make sure your name and NPN stays on their reenrollment application if they access it through on their own. Ifyour NPN is not entered, you may not receive credit for the re-enrollment.27

Active Re-enrollment via the Classic Private PartnerWebsite Pathway* If you are affiliated with a QHP issuer or web -broker that offers theClassic Private Partner Website Pathway, your name and NPN aretypically automatically transmitted electronically to the issuer when theconsumer’s re-enrollment is submitted in accordance with how theDirect Enrollment account was set up by the respective issuer or webbroker.After logging in to this pathway, use the Agent/Broker ApplicationSearch Tool to search for and help your client access his or her prepopulated plan year 2019 application.Once your client locates his or her pre-populated application,

Auto Re-enrollment Process. Step 1: CMS selects applications with current enrollment. Step 2: CMS pre-populates a plan year 2019 application in the background. The application is not visible to the consumer until November 1. Step 3: CMS creates a plan year 2019 enrollment using plan crosswalk provided by the issuer, or an alternate plan