The
time is fast approaching to do the first real assessment of how well the first
open enrollment period went under the Affordable Care Act,
California-style. CAHU’s top priority is
to work to empower our members with the ability provide equality, reliable
service to clients. A candid appraisal of the open enrollment challenges and
opportunities will ensure system and process problems are resolved, lead to
better client experiences in the future and strengthen the undisputable
conclusion that “agents are the answer”.
Here are a few
of the early issues:
Enrollment
Diversity Challenges:
Early indications of enrollment data by Covered California reveal that Latino,
African-American, Asian Pacific Islander enrollment results are below
demographic projections although there has been some success in Asian
populations mainly related to agent-engagement. Latino enrollment increased
from 21 percent to 26 percent. That is
an improvement from the last published results in February, but is still well
below projected enrollment expectations of Covered California. CAHU will be
updating the enrollment results for both businesses and individuals as more
official data becomes available.
To
address the challenge of enrollment California’s
many different cultural communities, CAHU Diversity Task Force is moving
forward and is at present engaging community groups in efforts to reach eligible
small businesses and identify uninsured individuals in preparation for the next
open enrollment period that begins in November 2014.
Advance
Premium Tax Credit: Covered California recently identified
about 3700 cases that were provided with an incorrect Advance Premium Tax
Credit (APTC) when the consumer selected their plan. Some consumers received
information that indicated an estimated APTC that was lower than the one they
will actually receive. A smaller group
were provided an estimate of APTC that was higher than what they will actually
receive in premium tax credits.
In
case a client calls regarding this issue, below is information that may help
agents answer questions:
·
The APTC amount was corrected in the
file sent to the carrier. This means the
consumer will be billed based on the correct APTC from the Eligibility Results
page.
- Approximately 3,100 of the cases are eligible for more APTC than displayed at plan check out (the premium they will be billed may be lower than expected from the screen).
- Approximately 635 of the cases are eligible for less APTC than displayed at plan check out (the premium they will be billed may be higher than expected from the screen). These consumers received the attached notice from Covered California –a copy of this notice will be in documents and correspondence in CalHEERS.
- The following recommendations have been provided to CAHU by Covered California in the form of a Q&A to assist our members if they encounter this issue:
What
should I do if I get a call from someone who got this letter?
• Thank
them for their call. Apologize for any trouble this oversight may have caused.
• If
the consumer is confused by their invoice, review their case in CalHEERS.
• Determine
if consumer is eligible for more or less APTC than expected from the plan check out page
(if this is case you’ll see this notice in the documents & correspondence folder in their case).
• Explain
the consequences if the consumer takes more APTC than is due to them
• If
the consumer wants to change their plan, submit their appeal
• There
is nothing to do in the system. The data fix has been applied.
Change
Request Form:
The long promised Change Request Form is almost ready for release by Covered
California. There will be two Change
Request forms; one for employee changes, and another one for employer update
and/or changes. These forms should be ready this week. In the interim,
please continue to send faxed changes into Pinnacle for updates. CAHU will post the form as soon as it is
available
Commissions: SHOP held a
webinar last week to discuss SHOP commissions. Commissions are expected to go
out near the end of April for the first few months of the year. Please
make sure that you have all of your information updated in the system.
Please note the following key points:
- SHOP commissions will be paid in late April. Commission will be based on payment made by enrolled groups through March 25.
- Payment will be made by check (direct deposit is not available at this time) and will be sent by the State of California Controller's office.
- Payment will be made to the name and address in box 2 of the Standard 204 form that you submitted during the certification process. The information in the Covered California profile that you established will not be used for these payments.
- A commission statement summarizing your book of business and how the commission was calculated will be sent by SHOP separately to the address listed in box 2 of the Standard 204 form.
- Statements will not be available through your Covered California portal.
- If you are not sure what information you included on the Standard 204 form, you can contact SHOP to ask for a copy. The email to use for this purpose is: agents@covered.ca.gov
·
If
you would like to request commission adjustments from SHOP follow these steps:
2. Put "SHOP Commissions" in the
subject line
3. Briefly describe the problem. Include
all relevant information such as the group name,
case number, coverage month, and etc.
“How
To” for Enrollments After March 31: Agents are facing some technical
challenges with enrollments that occur after March 31 but before April 15. Since open enrollment is technically over,
the Covered California system will ask you for the reason you are making a change
to enrollees’ applications that remain unprocessed. Please note that
agents, on behalf of their clients, will need to submit, under "life event that
caused the consumer to re-apply" - indicate open enrollment. Please
indicate the date of the application as March 31, 2014. That is the only
date that will permit the transaction to be completed.
Notices
for Unpaid Bills: There have been reports
that there have been some notices for unpaid bills from carriers in the SHOP
exchange that have been automatically generated by those carriers billing
areas. According to SHOP, please tell
your clients to ignore those letters as they need to pay the SHOP, not the
carriers directly.
On
the horizon: In the next
months, CAHU will examine more fully the breakdown of who enrolled (e.g.
previously uninsured vs. "churned" enrollment which simply moved from
plan to plan). A review of the data will provide insight to whether or not
there was a meaningful dent in the estimated 5.3 million Californians who lacked
coverage, and the extent to which agents were a factor in enrollments. Everyone will be looking at the total number
of insureds who have paid their premiums, and aggregate the source of these
paid enrollees amongst the categories of: agent-enrolled; direct self
enrollment by consumer; enrollment counselor and navigator enrollments.
I
am very happy to report that early estimates from Covered California already
clearly show that certified agents have been a powerful force in the engagement
and enrollment of Californians in healthcare under the ACA. CAHU will continue to make every effort to
find, development and implement sensible solutions to the many challenges
agents have faced and surmounted in the first open enrollment under the
ACA. It hasn’t been easy, but all of the
information you have shared on those challenges has been and will continue to
help make the system work better over time for your clients and all California looking for
the best health care at the most affordable price. Yes, CAHU’s thousands of agents really have proven themselves to be “the
answer.”
Until
Next Week,
Sam