ACA Learning Series Massachusetts Health Care Training Forum

October 2014

Massachusetts ACA Learning Series

The purpose of this ACA Learning Series is to educate

staff who currently assist Health Connector,

MassHealth and Health Safety Net (HSN) members at

Massachusetts hospitals, health centers and

community-based organizations

• Introduce key concepts and create awareness

• Deliver important, detailed information that will prepare you

for assisting populations you serve

• Provide you with specific information and training to help

populations obtain coverage

2

• Open Enrollment Overview

• Direct Member Contact and Member Mailings

• Update on Outbound Call Campaign

• Health Care for All Outreach and Education Campaign

• Messaging and Media

• Health Connector Products and Plans

• Health Connector Payments

• What You Need to Know

3

Agenda

Open Enrollment Overview

This year’s Open Enrollment period is from November 15,

2014 – February 15, 2015

• Individuals enrolled in the following programs WILL need to

submit a new application during open enrollment.

This includes:

‒ Qualified Health Plans (QHPs)

‒ Commonwealth Care (CommCare)

‒ Medical Security Program (MSP)

‒ Temporary MassHealth Coverage

‒ Temporary MassHealth Limited

5

Open Enrollment 2014-2015:

Overview

• Current MassHealth members who are receiving benefits

through the following MassHealth programs DO NOT need to

submit a new application during the Open Enrollment

period:

‒ MassHealth Standard

‒ CarePlus

‒ Family Assistance

‒ Limited

‒ Health Safety Net

‒ Children’s Medical Security Plan

‒ CommonHealth

6

Open Enrollment 2014-2015:

Overview (cont’d)

New hCentive End-to-End

Consumer Experience

7 7

Participant

creates

account

(Identity Mgt)

2. Apply

3. Verify

Eligibility

QHP[c] Bill Pay

Participant enters

through a single

Front Door for CCA

& MassHealth

(hCentive)

1. Front Door

Participant

completes

application

(hCentive)

QHP[a]

Shop

Application

data is

verified

(Federal Hub)

Participant provides

verification if

necessary

Eligibility and

MAGI program

is determined

(hCentive)

Participant chooses

plan – non state wrap

(hCentive)

Participant chooses

plan – state wrap

(hCentive)

Participant is

invoiced and

pays bill

(Dell)

Participant

receives

Proof of

Coverage

Portal or

Phone

Portal, Phone or Paper

QHP[d] Enroll

Qualified Health Plan

MH [a] Notification

Participant is noticed

(from hCentive to

MassIT)

Non-MAGI manual

processing

(Excel file to MA-21)

Assessed to be non-MAGI

Medicaid

MH [b] Enrollment

Eligibility information

is sent to MMIS for

enrollment

QHP[b] Notification

Participant is noticed

for QHP (Dell)

Currently Enrolled Populations

Count

(as of

9/8/2014)

End Date of

Existing

Coverage*

If eligible for Connector

Coverage, Deadline to

Apply and Select a Plan

(to avoid gap in

coverage)

If eligible for Connector

Coverage, Payment Due

Date

Qualified Health Plan (QHP) ~33K 12/31/2014 12/23/2014 12/23/2014

Commonwealth Care and

Network Health Extend (formerly

MSP)

~100K 1/31/2015 1/23/2015* 1/23/2015**

MassHealth Temporary Coverage

– Wave 1

~100K 1/15/2015 12/23/2014 1/23/2015**

MassHealth Temporary Coverage

– Wave 2

~100K 1/31/2015 1/23/2015 1/23/2015**

MassHealth Temporary Coverage

– Wave 3

~100K 2/15/2015 2/15/2015 2/23/2015**

Qualified Dental Plan/Small

Group Medical/ Small Group

Dental

~9K Varies by

anniversary date

Varies by anniversary

date

Varies by anniversary date

*End dates are tentative and subject to confirmation and approval from CMS (the Centers for Medicare and Medicaid Services)

**Members determined eligible for MassHealth and some subsidized QHP coverage will not need to submit payment

What we need to accomplish during the 2015 Open Enrollment period: • Outreach over 400,000 residents about open enrollment and applying for ACA-compliant coverage

• Assist all qualified persons in applying, shopping for and enrolling in a plan to avoid a gap in coverage

Open Enrollment 2014-2015:

Transitioning Populations

8

Multi-Faceted Outreach Campaign

Centralized member outreach data reporting to track and measure our progress.

This campaign will deliver a clear call-to-action to all populations

during Open Enrollment.

9

Enrollment Assisters

MassHealth and the Health Connector have started engaging and training the

Massachusetts enrollment assister community to prepare them for Open Enrollment.

Certified Application Counselors

The Commonwealth has approximately 170 Certified Application Counselor (CACs)

organizations spread across nearly all hospitals and Community Health Centers in the

Commonwealth. These organizations are responsible for 1,301 trained CACs. With an

potential for an additional 494 CACs are being trained for Open Enrollment

Navigators

The Commonwealth has selected 15 Navigator organizations that span across

Massachusetts. Following completion of the first phase of training and passing the

required exam, 85 Navigators have been certified. The Connector will be introducing

them to their communities via local media and press events

MassHealth and the Health Connector teams are also working to provide weekly updates in

the form of consolidated email blasts to the enrollment assister community on relevant

member transition and open enrollment topics 10

Direct Member Contact And

Member Mailings

Direct Member Mailings

• Beginning in October, we will send transitioning members a variety of direct

mailings

‒ Preview and payment reminder postcards to reinforce important dates and

provide calls to action to sign up

‒ Open Enrollment packets providing population-specific messaging, frequently

asked questions and details on where individuals can go to receive help applying

and enrolling

‒ E-mail blasts to members and authorized representatives to reinforce key mailings

including coverage extension notice, preview postcard, Open Enrollment packet

and payment reminder postcards

‒ Language about Open Enrollment highlighting important dates added to

operational letters and invoices sent to current members (e.g. NPP disenrollment

letter, closed enrollment welcome letter)

‒ To a certain subset of the subsidized population, paper applications (see next

slide)

Direct Member Contact

12

• We will direct our members to enroll online in all of our messaging, although

we will send paper applications to a subset of the population that might be

more likely to apply by paper

‒ For Commonwealth Care and Medical Security Program (MSP) members, we will

mail paper applications to ~35,000 individuals who did not reapply or who applied

by paper last year, specifically those who may have language barriers or who have

not had to pay a premium to remain in coverage

‒ For Temporary Medicaid members, we will mail paper applications in three waves

(in line with their coverage end dates) to ~115,000-150,000 households that

applied by paper last year. Final numbers will depend on the final count of

individuals in temporary Medicaid (~285,030 members as of August 30, 2014)

‒ We have also assessed the current workforce who enters these applications and

will augment accordingly to mitigate paper backlogs and to ensure that

applications get processed in a timely manner

• Even those that receive paper applications will still be educated that the

fastest and easiest way to apply for coverage this Open Enrollment is online

Direct Member Contact (cont’d)

13

• Our communications messages will vary by the priority population and are

informed by their proposed coverage end dates (outlined below)

• Each population will receive the following pieces of direct mail that will

provide specific instructions on how to submit a new application, where to

receive assistance, and reinforce the call to action:

‒ Coverage Termination Letter

‒ Open Enrollment Packet

‒ Application Reminder Postcards

Direct Member Mailing

QHP

CommCare /

MSP

Temporary MH

Wave 1

Temporary

MH Wave 2

Temporary

MH Wave 3

Call-to Action

Notice Mail Date Nov. 13, 2014 Nov. 13, 2014 Nov. 15, 2014 Dec. 1, 2014 Dec. 15, 2014

Color Coded

Banner of Notice Grey Orange Purple Blue Green

Coverage End

Date Dec. 31, 2014 Jan. 31, 2015 Jan. 15, 2015 Jan. 31, 2015 Feb. 15, 2015

14

October November December January February

QHP (~33K)

CommCare /

MSP

(~100K)

Temporary

Medicaid Wave 1

(~100K)

Temporary

Medicaid Wave 2

(~100K)

Temporary

Medicaid Wave 3

(~100K)

Automated and Live Agent Outbound Calls (~2.3M calls deployed)

Door Knocking Campaign (target 200,000 doors)

10/20 11/3 12/8 1/12 2/9

1/12

12/31

12/15 1/12 2/15

12/1 1/31

11/3 12/8 1/12 2/9 1/31 11/17

Preview Postcard

Coverage End Date

Open Enrollment

Packet

Paper Application

Reminder Postcard

11/15 1/12 1/15

15

Direct Member Mailing (cont’d)

Each Commonwealth Care member will receive a bill insert included

with their last premium invoice sent on January 1, 2015

Commonwealth Care Bill Insert

16

• Commonwealth Care members will be

provided messaging highlighting the need

to apply for coverage in 2015

Note: This is an example of the mailing to Commonwealth

Care members. Individuals with temporary MassHealth

will receive a similar packet with tailored information

Application Messaging for

Commonwealth Care Members

17

• Commonwealth Care members will be

provided with responses to frequently

asked questions to support

application and enrollment

I already applied last year. Do I need to

apply again?

When should I apply for health

insurance?

What happens if I don’t enroll before

January 23?

How do I get help paying for coverage?

Frequently Asked Questions for

Commonwealth Care Members

18

• Commonwealth Care members will

be provided a list of information

needed to apply for, and enroll in,

2015 coverage

Application Checklist for

Commonwealth Care

19

• Commonwealth Care members will be

provided messaging in the distributed

open enrollment packet on the

significance and availability of

Navigators and Certified Application

Counselors

Navigator Messaging for

Commonwealth Care Members

20

Update on Outbound Call

Campaign

Outbound Call Campaign

• We are engaging in an outbound call campaign beginning in November

‒ Transitioning members will receive phone calls before, during and after the Open

Enrollment period

‒ New applications will also receive calls after account creation/application submission to

help encourage them to complete the shopping, payment and enrollment process

• Approximately 2.3 million calls will be deployed in total

‒ Automated calls will be deployed to new and transitioning members. The purpose of these

calls is to reinforce messaging provided in member mailings, remind individuals to

complete partial action taken online and provide next steps, and to confirm payment when

received. Automated calls will also leave voicemail messages when available

‒ Live agent calls will be deployed to provide education and enrollment support to

transitioning members-providing support with application, plan selection and payment

• The call campaign staffing model will include 125 agents trained for outbound calls

Outbound Call Campaign

22

Health Care for All Outreach and

Education Campaign

We are again partnering with Health Care For All this year to continue its

grassroots, public education campaign for the upcoming Open Enrollment

period.

• Health Care For All will execute a door knocking campaign designed to target 200,000 doors to

inform consumers of the need to apply for 2015 coverage and where they can receive

assistance in their community

• Their effort will also feature an ethnic and local media campaign targeting over 500,000

consumers informing them of the need to take action

• Health Care for All will deploy a password-protected, invitation only online discussion platform

– known as In The Loop- for the Massachusetts enrollment assister community to share direct

experience and questions in a monitored forum that will offer peer support, trouble shooting,

and consistently accurate and timely technical assistance to this secure community

‒ This community is modeled after the successful federal model that is supporting enrollment

assisters across the country enrolling consumers through Healthcare.gov

‒ HCFA will report back trends/issues they see on In the Loop to the Health Connector and

MassHealth, as a feedback loop

‒ The Health Connector and Health Care for All look forward to providing a more in depth training

on how enrollment assisters can soon take advantage of this beneficial platform

Health Care for All Outreach and

Education Campaign

24

Messaging and Media

Messaging

• Each month, leading up to – and through –

open enrollment, the Health Connector will

email enrollment assisters a set of approved

talking points providing timely and consistent

information you can share directly with the

consumers you serve

Media Plan

• The Health Connector’s public outreach and

education campaign will run throughout Open

Enrollment, with heavier rotation through

December, featuring Navigators giving a clear

call-to-action to current members and offering

assistance

• Press outreach includes upcoming Navigator

tour and education and enrollment events;

media roundtables and demonstrations of the

system; access to the Operations Command

Center during the first stage of Open

Enrollment

Messaging and Media Plan

Working Television Story Board

26

Health Connector

Products and Plans

The Health Connector Marketplace

Under the ACA, the Health Connector is the Massachusetts Marketplace, serving

both individuals and families as well as small businesses

Individual Marketplace

‒ Individuals and families can buy coverage for themselves in the Individual Marketplace

‒ Self employed consumers can buy in the Marketplace if they are buying coverage for

themselves and their families (not their employees)

SHOP (Small Business Health Options Program) Marketplace

‒ Small business owners (businesses with 50 or fewer full time equivalent employees) can

purchase a product called “Business Express” which is a sole source offering, meaning

employers can select 1 medical plan to offer all of their employees

‒ Unlike the Individual Marketplace, small business owners and their employees

participating in SHOP can’t qualify for Marketplace programs to lower their costs (e.g.

premium tax credits and cost-sharing reductions)

Individuals and families applying for coverage through MAhealthconnector.org may

be eligible for coverage sponsored by MassHealth or the Health Connector

MassHealth programs

QHPs without financial assistance, including catastrophic health plans

QHPs with financial assistance (tax credits, cost-sharing reductions, ConnectorCare)

QDPs

28

QHP: A health benefit plan that is approved by the MA Division of Insurance for

meeting applicable state and federal requirements, including limits on cost-

sharing (e.g., deductibles, copayments, and out-of-pocket maximum amounts)

and coverage of essential health benefits, and has received the Health

Connector’s Seal of Approval as meeting certain standards regarding quality,

value, and coverage

QDP: A dental benefit plan that is approved by the MA Division of Insurance for

meeting applicable state and federal requirements, including reasonable limits

on cost-sharing and coverage of the pediatric oral services essential health

benefit, and has received the Health Connector’s Seal of Approval as meeting

certain standards regarding quality, value, and coverage

What are Qualified Health Plans (QHPs) and Qualified Dental Plans

(QDPs)?

Health Connector

Products and Plans

29

Products Description

Qualified Health Plans (QHPs) with

financial assistance for individuals

and families

• Federal subsidies: premium tax credits (0%-400% FPL) can be applied

to QHPs on any metallic tier; cost-sharing reductions (0%-250%* FPL)

can be applied to certain Silver tier products (ConnectorCare plans)

• Health Connector will provide additional state subsidies (0%-300% FPL)

through the ConnectorCare program which is only available on the Silver

tier

QHPs without financial assistance

for individuals and families

• Unsubsidized plans for eligible individuals and families offered on four

metallic tiers

Catastrophic Health Plans for

individuals and families

• Catastrophic plans for young adults <30; and individuals and families

otherwise eligible because they have an exemption under federal law

• Covers preventive care in full without cost-sharing and offers at least 3

non-preventive primary care office visits without applying toward the

deductible

QHPs for small businesses

• Coverage for small businesses with <50 employees

• Certain small businesses may be eligible for federal tax credits or state

wellness rebates

Qualified Dental Plans (QDPs) for

individuals, families and small

businesses

• Dental plans for eligible individuals and small groups

• Pediatric-only plans are available too

• Dental benefits may be embedded in Health Plans or offered as a Stand-

Alone Plan by dental issuers

*Cost Sharing Reductions (CSRs) are available for American Indians with income up to 300% of FPL

Health Connector

Products and Plans (cont’d)

30

Standardized Plan Design – Metallic Tiers

• Plans offered through the Health Connector are primarily separated into 4 health

plan categories — Bronze, Silver, Gold, and Platinum — based on the percentage

the plan pays of the average overall cost of providing essential health benefits to

members. The plan category you choose affects the total amount you'll likely

spend for essential health benefits during the year

Health Connector

Products and Plans (cont’d)

31

Health Connector Issuers for 2015:

• Altus Dental (offers dental only)

• BCBSMA (offers medical and dental, but dental is only for small businesses)

• Boston Medical Center HealthNet Plan (a ConnectorCare Issuer)

• CeltiCare Health Plan (a ConnectorCare Issuer)

• Delta Dental of MA (offers dental only)

• Fallon Health Plan (a ConnectorCare Issuer)

• Guardian (offers dental only, but only for small businesses)

• Harvard Pilgrim Health Care

• Health New England (a ConnectorCare Issuer)

• MetLife (offers dental only, but only for small businesses)

• Minuteman Health (a ConnectorCare Issuer)

• Neighborhood Health Plan (a ConnectorCare Issuer)

• Tufts Health Plan - Network Health (a ConnectorCare Issuer)

• Tufts Health Plan

• UnitedHealthcare

Health Connector

Products and Plans (cont’d)

32

ConnectorCare Program

33

Who can qualify for a ConnectorCare Plan?

Individuals or families living in Massachusetts with

incomes at or below 300% of the Federal Poverty

Level (FPL) may qualify for ConnectorCare.

• If you and your family qualify, your Plan Type will

depend on your household income.

• Those with incomes above 300% FPL cannot

qualify for a ConnectorCare plan, but may

qualify for tax credits that help to lower the cost

of insurance.

ConnectorCare Program

(cont’d)

Based on where you live, you may be able to choose from

plans offered by the following insurers:

• Boston Medical

• Center HealthNet Plan

• CeltiCare Health

• Fallon Health

• Health New England

• Minuteman Health

• Neighborhood Health Plan

• Tufts Health Plan - Network Health

These health plans offer the same core set of services but may have different

doctors or hospitals in their provider networks. Be sure to check out each plan in

your area to see if your doctor or hospital is in the network.

34

ConnectorCare Program

(cont’d)

In addition to income eligibility, ConnectorCare members must:

• Live in Massachusetts

• Be a US Citizen, National, or immigrant that is lawfully present in

the United States

• Not qualify to enroll in an employer’s affordable, comprehensive

health insurance

• Not be in jail

• Not qualify for Medicare, MassHealth (Medicaid) or other public

health insurance programs

35

ConnectorCare Program (cont’d)

36

Which Connector Care can you qualify for? The cost of ConnectorCare plans are different, depending on the health

insurer and your Plan Type. The charts below shows the income eligibility for

different Plan Types according to Federal Poverty Levels (FPL).

Sample of ConnectorCare monthly premiums.

ConnectorCare Fact Sheet

37

ConnectorCare Plans:

A new way to help you pay for

health insurance

Fact Sheet includes:

• Who can qualify for a

ConnectorCare plan?

• Which ConnectorCare plan

can you qualify for?

• Lowest cost

ConnectorCare plan

premiums 2015

• ConnectorCare Benefits

and Copays Chart

Health Connector Payments

What are Premiums?

• Health and dental plan premiums are monthly payments that

a member must pay in order to establish and maintain

coverage

• Unlike co-payments and deductibles, some members will pay

a premium each month, regardless of whether the member

received health or dental care

• Members who qualify for ConnectorCare plans could have $0

premiums, depending on their eligibility determination and

plan selection. All other Health Connector members will likely

pay a premium every month

• The following information does not apply to individuals

determined eligible for MassHealth

39

Payments Deadlines

• The payment due date for all Individual/Family (non-group) products is the

23rd of every month before the next coverage effective date (the 1st of a

month)

• For example, December 23rd is the payment due date for coverage effective

January 1st

Payment Deadline Coverage Effective Date

December 23, 2014 January 1, 2015

January 23, 2015 February 1, 2015

February 23, 2015 March 1, 2015

March 23, 2015 April 1, 2015

April 23, 2015 May 1, 2015

May 23, 2015 June 1, 2015

June 23, 2015 July 1, 2015

40

Paying the Health Connector

• The Health Connector generates a quote (a premium priced according to the

applicant’s eligibility and unique characteristics) and sends it to an applicant

after the applicant has applied for coverage and selected a plan

• The applicant pays the quote (premium) using one of the available payment

methods (Check, Money Order, Bank ACH, in person)*. All payment must be

received in full and on time for coverage to be effective the following month

and for the applicant to become a member/enrollee of the insurance carrier’s

plan

• The Health Connector processes payment and sends confirmation to the

insurance carrier

• A Welcome Letter is mailed to a member by the Health Connector within 5

business days of processing payment and sending confirmation to the carrier

• The insurance carrier produces a member ID number and mails a member

packet and card to the enrollee approximately 7-10 business days after

receiving the member’s information *The Health Connector is currently building an Electronic Funds Transfer (EFT) payment

system that will go live during Open Enrollment. 41

Paying the Carrier

• Members have the right (pursuant to the ACA) to pay a carrier (health plan)

directly; however, the fastest and easiest way for a member to pay is to do

so directly through the Health Connector. If the member chooses to pay the

carrier directly, the carrier is responsible for establishing a process for

collection of premium payments

• An enrollee must pay his/her monthly premium in full by the payment due

date each month* and follow any process established by the carrier

• Please note: ConnectorCare members must pay the Health Connector

directly to ensure that they receive all available federal and state subsidies

*Each carrier has its own payment due date that may be different from the Health Connector’s

42

Partial Payments for New Members

• If an initial premium payment is equal to or less than $10 short of the total

amount due, it will be accepted for new members and the member will be

enrolled

• The member will then be billed for the balance on their next ongoing billing

statement

• This $10 payment policy is also applicable to plan changes made at the time of

renewal or during Open Enrollment

• If a member makes an initial payment that is more than $10 short of the total

amount due, the member will not be enrolled. It is, therefore, important to

emphasize to members that full payment is required

Example: Premium is $100, member sends in a check

for $90 – member will be enrolled, but next month will

owe $110 (the balance plus the monthly premium).

Example: Premium is $100, member sends in a check

for $80 – member will not be enrolled until they pay the

amount due or an amount within $10 of the amount due. 43

Partial Payments for Ongoing Customers

Partial Payment:

• Applies to enrolled Individuals, Families, Employers, or Employees

• Premium payment received that is less than the total amount due

• Treated as a non-payment for the purposes of calculating the

member’s delinquency status and terminations for non-payment

• Could result in the suspension or denial of claims by the health plan

• All payments are applied to outstanding fees on the account before

they are applied to premium balances

Note: The Health Connector may choose to round up to the nearest full dollar amount and use the

rounded amount to calculate member delinquency status and termination for non-payment

44

Payment and Processing for Ongoing

Customers

Ongoing Payment Process and Deadlines:

• On an ongoing basis, the payment due date for all non-group (individual/

family) products and coverage types is the 23rd calendar day of the month

before coverage effective date

• The payment due date for all small group products is 5 business days

before coverage effective date

• Payment must always be made in advance of the coverage month

• An enrollee must pay his/her monthly premium in full by the payment due

date each month or will be considered delinquent and risk disenrollment

for non-payment

• All payments are always applied to outstanding balance and/or fees on the

account before they are applied to premium balances

Note: Plan selection deadlines for small group coverage vary by insurance carrier, but the

payment deadline is always the same regardless of which insurance carrier the group enrolls in.

45

Payment Methods

Available Payment Methods

‒ By mail by check or money order (paper)

‒ In person at the Customer Service Center in Boston or Worcester (check or money order only)

‒ Sent by the enrollee’s bank or financial institution; search for ‘MA Health Connector’ in the bank’s bill-pay to find the correct payee

‒ By Electronic Funds Transfer (EFT) payment online*

• Payments are processed and credited to member’s account the same day they are received provided the payment was submitted with all necessary information (e.g., member’s correct billing account number that can be found on the bill, etc.)

• Payments that do not have correct or sufficient information will be cashed and placed in a suspense account – this means they cannot be credited to a member’s account

• Payments are researched daily to attempt to associate the payment with a member account

• If a payment cannot be associated with a member premium billing account, it will remain in suspense until the member calls. When calling, members should have their check ready, customer service will ask for a copy of front and back of the check. Once received, payment will be transferred from suspense to member’s account

*The Health Connector is currently building an Electronic Funds Transfer (EFT) payment system that will go live during Open Enrollment. 46

Payment Methods

Current Payments

Commonwealth

Care

P.O. Box 849175

Boston, MA 02284

Health Connector

P.O. Box 970008

Boston, MA 02297

Commonwealth

Care payments

2014 Medical and Dental

2014 Small Group Dental

Plans

In-Person Payments

133 Portland Street, 1st floor

Boston, MA 02114-1707

146 Main Street Suite 201/202

Worcester, MA 01608

NEW! - MA Health Connector

MA Health Connector PO Box 970063 Boston, MA 02297-0063

2015 Medical and Dental 2015 Small Group Dental Plans Note: When working with members, please explain that the Name and PO Box has changed. Please update any automatic payments that have been set up to pay for health insurance premiums.

Note: This address

should be used when

sending an overnight

payment

47

Improperly Submitted Payments

• From time to time, the Health Connector receives a payment that

cannot be processed. Payments that do not contain sufficient or

correct information may prevent accurate and prompt payment

processing and account crediting with the following possible results:

‒ Payments not being applied to a member’s account

‒ Late application of payment to the member’s account

• In such cases, the member’s account will be considered delinquent

‒ An actively enrolled member will become delinquent and eventually

subject to disenrollment

‒ A new customer will not be enrolled or enrolled late

48

Late Payments

• A member must pay the monthly premium in full by the

payment due date each month

• A payment received after the payment due date is treated as

non-payment for the purposes of activating the new member’s

enrollment, calculating delinquency status, and terminations

for non-payment

• A late payment may result in:

‒ Activating enrollment with a later effective date, or

‒ Not activating enrollment for newly enrolling individuals, families,

employers or employees

‒ Becoming delinquent and receiving delinquency notices

‒ The suspension or denial of claims by the insurance carrier for

healthcare services rendered

49

What You Need To Know

• Individuals who have a Qualified Health Plan, Commonwealth Care, Medical Security

Plan, or temporary MassHealth coverage (including temporary Limited) MUST submit a

new application during fall Open Enrollment

• Enrollment assisters DO NOT have to wait until a consumer receives a termination letter

to help them apply for coverage during Open Enrollment – applying early is the best way

to avoid gaps in coverage!

• The Commonwealth is prepared to execute a multi-faceted outreach campaign targeting

the transition of legacy or temporary coverage members into new, ACA-compliant

coverage

• This campaign will drive consumers to leveraging the new online application platform

that will make the application and enrollment process easier than ever for customers

‒ The system will determine eligibility for non-disabled individuals under the age of 65. All

individuals 65 and older and disabled individuals will need to continue to use the paper

Application for Health Coverage for Seniors and People Needing Long-Term-Care Services

• Paper applications will be made available, but completing an online application is the

fastest way to receive a determination and enroll in coverage

What You Need To Know

51

EVS Messaging

• Individuals with CommCare Coverage

‒ “This member’s Commonwealth Care coverage is ending soon! They

need to submit a new application on or after November 15, 2014 at

Mahealthconnector.org”

• Individuals with Temporary MassHealth (including Limited)

Coverage

‒ “This member’s temporary benefits are ending soon! They need to submit a

new application on or after November 15, 2014 at Mahealthconnector.org”

• Both messages will be available in Appendix Y

52

Customer Service

• For assistance with Connector coverage or questions about

the website visit MAhealthconnector.org or call 1-877 MA

ENROLL (1-877-623-6765) or TTY 1-877-623-7773, Monday

to Friday, 8:00 a.m. to 6:00 p.m.

‒ During open enrollment, you can call Monday to Friday, 7:00 a.m. to

7:00 p.m. and Saturdays, 9:00 a.m. to 3:00 p.m.

‒ Go to MAhealthconnector.org for information on special dates during

Open Enrollment when they will have even longer hours.

• For questions with MassHealth coverage Call the MassHealth

Customer Services Center at 1-800-841-2900 or TTY: 1-800-

497-4648, Monday to Friday, 8:00 a.m. to 5:00 p.m.

53

Questions?