Consumer Eligibility and Enrollment Call-Flow Wrap-Up

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MARKETPLACE TRAINING
INSTRUCTOR GUIDE
CONSUMER ELIGIBILITY AND
ENROLLMENT CALL-FLOW
WRAP-UP
Revised: January 2014
Instructor Guide
Consumer Eligibility and Enrollment Call-Flow Wrap-Up
THIS PAGE INTENTIONALLY LEFT BLANK
INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been
publicly disclosed and may be privileged and confidential. It is for internal government use only and must not be
disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure
may result in prosecution to the full extent of the law.
Instructor Guide
Consumer Eligibility and Enrollment Call-Flow Wrap-Up
TABLE OF CONTENTS
Introduction .................................................................................................................................... 1
Description .................................................................................................................................. 1
Instructions ................................................................................................................................. 1
Part 1: Help George Create a Marketplace Account ...................................................................... 2
Part 2: Complete an Application for the Price Family .................................................................... 4
Begin the Call .............................................................................................................................. 4
Accessing the CSR Application Tool ............................................................................................ 5
Getting Started............................................................................................................................ 7
Family and Household............................................................................................................... 11
Income ...................................................................................................................................... 13
Additional Information ............................................................................................................. 15
Review and Sign ........................................................................................................................ 16
Part 3: Tell the Price Family About Their Eligibility....................................................................... 17
Part 4: Help the Price Family Choose Coverage............................................................................ 18
Part 5: Help the Price Family Enroll and Pay for Coverage ........................................................... 24
INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been
publicly disclosed and may be privileged and confidential. It is for internal government use only and must not be
disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure
may result in prosecution to the full extent of the law.
ii
Consumer Eligibility and Enrollment Call-Flow Wrap-Up
Instructor Guide
INTRODUCTION
Description: The Consumer Eligibility and Enrollment Call-Flow Wrap-Up involves role-playing to
help class participants solidify their knowledge of the tools and processes used at every stage of
the consumer’s path to obtaining health coverage. The activity also gives participants
opportunities to practice answering consumer questions. In each part of the activity,
participants take turns assisting a fictional consumer and talking through the tasks necessary to
complete an application, compare Marketplace plans, and enroll in a plan.
Instructions: To facilitate this role-play, you will:
1. Explain to participants they will be participating in role-playing in which they will
pretend to take consumer calls and role-play through each tool screenshot in the
PowerPoint presentation until the process is completed and the fictional consumer is
satisfied.
2. Tell the class:
a. You (the instructor) will play the role of the consumer.
b. A class participant will play the role of the customer service representative (CSR)
for each tool screen shown; multiple people may end up contributing to the
same part of the activity, although each participant must talk through at least
one screen.
c. The rest of the class will play the role of the Internal Support Group (ISG).
3. Ask a volunteer to begin. Participants may remain in their seats.
4. Read the scenario and pretend to place a call to the CSR. Play the role of the consumer
described in the scenario.
Important: Read the instructor notes on the following pages carefully. These notes
indicate questions the consumer might ask and responses the CSR must provide to
complete each screen successfully.
Note: The participant version of this document includes only the Suggested Activities
rows in the tables that follow, starting on the next page.
5. Provide the following instructions before you begin. Ask each volunteer to do the
following:
a. Describe how they would handle the consumer questions and would use the
tools to get appropriate information from the consumer.
b. Tell what reference materials they would use.
c. Ask you (the consumer) probing questions and/or ask the class for help, if
needed.
Note: Encourage participants to review training materials.
6. Lead the class in a round of applause for each volunteer.
7. Continue until the activity is complete.
INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been
publicly disclosed and may be privileged and confidential. It is for internal government use only and must not be
disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure
may result in prosecution to the full extent of the law.
1
Consumer Eligibility and Enrollment Call-Flow Wrap-Up
Instructor Guide
PART 1: HELP GEORGE CREATE A MARKETPLACE ACCOUNT
Item
Scenario
Read to
CSR
Instructor
Notes
Suggested
Activities
CALL
OPENING
Description
The consumer, George Williams, is a 45-year-old single man, living in Arkansas. He
has begun setting up his Marketplace account, but is having trouble creating a
password that the tool will accept.
“Hi, my name is George Williams. I’m trying to create my account on
HealthCare.gov, but the website won’t take my password. ”
• George does not have a prior Contacts record.
• George is trying to create a password that includes his user name.
1. Greet George appropriately and obtain his contact information.
2. Restate George’s problem and ask for clarification, as necessary.
3. Indicate you’re not allowed to create an account for him, but you’ll be happy
to help him determine what’s going on.
You will be scored on your ability to restate or paraphrase the consumer’s issue
and correctly assess the reason(s) for the call.
Suggested
Activities
SCREEN 1
1. Ask probing questions until you determine George is trying to create a
username and password that are the same.
2. Tell George his password may not contain his username or any of the other
prohibited characters shown beneath the Password field.
3. Restate you’re not allowed to create the account for him, but you’ll be happy
to answer any other questions he may have.
You will be scored on your ability to use probing questions to further explore the
consumer’s issues as needed.
Instructor
Notes
• George asks the CSR to stay on the call while he finishes creating his account.
• On screen 2, George asks, “Why do I need security questions?
Suggested
Activities
SCREEN 2
1. Respond to George’s question: Security questions enable him to change his
password or unlock his account, if needed.
You will be scored on your ability to provide accurate information to the
consumer.
INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been
publicly disclosed and may be privileged and confidential. It is for internal government use only and must not be
disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure
may result in prosecution to the full extent of the law.
2
Consumer Eligibility and Enrollment Call-Flow Wrap-Up
Instructor Guide
Help George Create a Marketplace Account — continued
Item
Instructor
Notes
Suggested
Activities
SCREEN 3
Instructor
Notes
Suggested
Activities
CALL END
Description
• George successfully creates his account, selects the email link to activate his
account, and logs in to his Marketplace account.
• George asks for a tour of the Marketplace account: “What’s useful about this?
What can I do here?”
1. Talk through the elements of the Account Home screen:
a. Logout link
b. Home screen news
c. MY APPLICATIONS & COVERAGE
d. MY PROFILE
• George thanks the CSR for their help and says he has what he needs.
1. Thank George and end the call appropriately.
INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been
publicly disclosed and may be privileged and confidential. It is for internal government use only and must not be
disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure
may result in prosecution to the full extent of the law.
3
Consumer Eligibility and Enrollment Call-Flow Wrap-Up
Instructor Guide
PART 2: COMPLETE AN APPLICATION FOR THE PRICE FAMILY
Begin the Call
Item
Scenario
Read to
CSR
Instructor
Notes
Suggested
Activities
CALL
OPENING
Instructor
Notes
Description
The consumer, a married woman named Donna Price, would like to enroll her
family in affordable coverage through the Marketplace. She calls the Marketplace
to begin the process and complete the application. The CSR Application Tool
cannot be accessed, so you need to complete the online application on behalf of
Donna.
Donna (37) and her husband, Raymond (39), are not offered coverage by their
employers. They live in Texas and have 3 children: Matteo (11), Brittany (13), and
Tomas (16). No one in the family smokes or has a pre-existing health condition.
Together, Donna and Raymond make $47,000 a year, so Donna is looking for any
financial help for which she and her family may be eligible.
“Hi, my name is Donna Price. I want to get health insurance for my family. We
can’t afford much, but I know we have to buy it. Can you help me?”
• Donna does not have a prior Contacts record, and neither does Raymond.
1. Greet Donna appropriately and obtain her contact information.
2. Restate Donna’s request.
3. Indicate you’ll be happy to complete the Marketplace application for Donna
and her family.
You will be scored on your ability to restate or paraphrase the consumer’s issue
and correctly assess the reason(s) for the call.
• Donna’s information should be recorded on the Next Generation Desktop
(NGD) Dashboard, so she is not asked to repeat this information throughout
the application process.
INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been
publicly disclosed and may be privileged and confidential. It is for internal government use only and must not be
disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure
may result in prosecution to the full extent of the law.
4
Consumer Eligibility and Enrollment Call-Flow Wrap-Up
Instructor Guide
Accessing the CSR Application Tool
Item
Suggested
Activities
SCREEN 1
Description
1. On the FFM Contacts screen, select the Consumer Applications view.
2. Select the Create EZ App button. The CSR Application Tool opens in a new
window.
Suggested
Activities
SCREEN 2
1. On the CCR Marketplace Application Access screen, enter your NGD user ID
and password, and select the Sign In button.
Instructor
Notes
Suggested
Activities
SCREEN 3
• Access the CSR Application Tool to determine if you can use the tool to help
Donna enroll in coverage.
1. On the Welcome Call Center Representative! screen, select the GO TO
SCREENER button.
Instructor
Notes
Suggested
Activities
SCREEN 4
• Get started with the Screener.
Instructor
Notes
• Donna has not already started an application.
Suggested
Activities
SCREEN 5
1. Ask Donna what state she is applying for coverage in.
2. Select Texas from the Select One drop-down menu.
3. Select the NEXT button.
Instructor
Notes
• Donna is applying for coverage in the state of Texas.
Suggested
Activities
SCREEN 6
1. Confirm with Donna that she is looking for coverage for herself and her family.
2. Select the appropriate radio button.
3. Select the NEXT button.
Instructor
Notes
• Donna is looking for coverage for herself and her family.
1. Ask Donna if she has already started an application.
2. Select the No radio button.
3. Select the NEXT button.
INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been
publicly disclosed and may be privileged and confidential. It is for internal government use only and must not be
disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure
may result in prosecution to the full extent of the law.
5
Consumer Eligibility and Enrollment Call-Flow Wrap-Up
Instructor Guide
Accessing the CSR Application Tool — continued
Item
Suggested
Activities
SCREEN 7
Instructor
Notes
Suggested
Activities
SCREEN 8
Instructor
Notes
Description
1. Ask Donna each of the questions on the screen and select the appropriate
radio button for each answer.
2. Select the GO TO EZ APPLICATION button.
• Donna is applying for coverage for herself and her family members.
• Donna would like to find out if she and her family can get help paying for
coverage.
• Everyone applying for coverage has the same home address as Donna, and are
included on her 2014 tax return.
• Everyone on Donna’s tax return is applying for coverage.
• No one applying for coverage has ever been in foster care.
• No one applying for coverage is incarcerated.
• Everyone applying for coverage has a permanent home address.
• No one applying for coverage is temporarily living outside of Texas.
1. Close the EZ Application and return to the NGD to select the Create Online
Application button, launching the complete online application.
• You need to complete the full Marketplace application on the NGD on behalf
of Donna, but you cannot access the CSR Application Tool. You access and
complete the full Marketplace online application on behalf of Donna.
• You would do this by selecting the Create Online Application button in the
Applications view.
INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been
publicly disclosed and may be privileged and confidential. It is for internal government use only and must not be
disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure
may result in prosecution to the full extent of the law.
6
Consumer Eligibility and Enrollment Call-Flow Wrap-Up
Instructor Guide
Getting Started
Item
Suggested
Activities
SCREEN 1
Instructor
Notes
Suggested
Activities
SCREEN 2
Suggested
Activities
SCREEN 3
Description
1. Review the 6 steps of the Getting Started process with Donna.
a. Privacy Policy
b. Contact Information
c. Help Applying for Coverage
d. Help Paying for Coverage
e. Who Needs Coverage
f. Summary
2. Read the Start Your Application screen text to Donna.
3. Select the NEXT button to continue to the Privacy Policy section.
• Donna has no questions at this point.
1. Read the Privacy Policy on the Privacy & Use of Your Information screen.
2. Ask Donna to confirm her agreement with the policy and get her permission to
select the check box.
3. Select the check box.
4. Select the SAVE & CONTINUE button and move to the Contact Information
section.
1. Confirm Donna’s name.
2. Select the Update Name button to update, if needed.
Instructor
Notes
• 123 Number Street, Abilene, TX 79699
• The members of her family are Raymond, Matteo, Brittany, and Tomas, and
they all live at the same address.
Suggested
Activities
SCREEN 4
1. Confirm Donna’s mailing address is the same as her home address.
2. Select the Yes radio button.
Instructor
Notes
Suggested
Activities
SCREEN 5
• It is the same.
Instructor
Notes
1. Ask Donna for her phone number.
2. Select Home, Cell, or Work from the drop-down menu.
3. Ask what language is the preferred spoken and written language used in the
home.
• The CSR is able to confirm Donna’s phone number is correct.
• Donna does not wish to answer the language question. Ask the CSRs “What
should you do?”
INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been
publicly disclosed and may be privileged and confidential. It is for internal government use only and must not be
disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure
may result in prosecution to the full extent of the law.
7
Consumer Eligibility and Enrollment Call-Flow Wrap-Up
Instructor Guide
Getting Started — continued
Item
Description
Suggested
Activities
SCREEN 5
(continued)
Suggested
Activities
SCREEN 6
1. Explain to Donna it’s helpful to know the background of the consumers who
are applying for health coverage, but this part is optional, so she does not have
to indicate a preferred language.
Instructor
Notes
• Question: Do you want to read your notices about your application on this
website?
• Answer:
o No, I want to get paper notices sent to me in the mail.
1. Read the information on the screen about authorized representatives.
2. Ask Donna if she would like to add an authorized representative, and select
the Yes or No radio button to make the choice she indicates.
3. Select the SAVE & CONTINUE button.
• Donna would like to add an authorized representative.
Suggested
Activities
SCREEN 7
Instructor
Notes
1. Ask Donna the question.
2. Select the Yes or No radio buttons.
3. Select the SAVE & CONTINUE button.
Suggested
Activities
SCREEN 8
1. Select the Add Authorized Representative button.
2. Select the SAVE & CONTINUE button.
Instructor
Notes
• Donna would like you to add her husband, Raymond, as an authorized
representative.
1. Ask Donna whether Raymond has a Marketplace account on the
HealthCare.gov website.
2. Ask Donna for Raymond’s full name and email address, and complete the fields
as appropriate.
3. Select the NEXT button.
• Raymond does not have a Marketplace account.
• Raymond’s email is [email protected]
Suggested
Activities
SCREEN 9
Instructor
Notes
INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been
publicly disclosed and may be privileged and confidential. It is for internal government use only and must not be
disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure
may result in prosecution to the full extent of the law.
8
Consumer Eligibility and Enrollment Call-Flow Wrap-Up
Instructor Guide
Getting Started — continued
Item
Description
Suggested 1. Read the authorized representative’s information and the agreement
Activities
statement to Donna.
SCREEN 10 2. Ask Donna to confirm she agrees.
3. Select the check box.
4. Select the NEXT button.
Instructor • Donna confirms Raymond as her authorized representative.
Notes
• Donna agrees with the statement.
Suggested 1. Confirm for Donna that Raymond has been designated as her authorized
Activities
representative.
SCREEN 11 2. Note that Raymond’s status as authorized representative will be pending until
he accepts it.
3. Select the SAVE & CONTINUE button.
Instructor • The authorized representative status is pending.
Notes
Suggested 1. Ask Donna whether any of the people listed on the Help applying for coverage
Activities
screen are helping her with her application.
SCREEN 12 2. Select the None of these people radio button.
3. Select the SAVE & CONTINUE button.
Instructor • Donna confirms she is not getting help from anyone else on her application.
Notes
Suggested 1. Tell Donna you are completing a screen that asks her to confirm the people
Activities
who will be covered by her application.
SCREEN 13 2. Read the radio button options.
3. Make the selection as she directs.
4. Ask Donna whether she and her husband file their taxes jointly or separately.
5. Select the SAVE & CONTINUE button.
Instructor • Ask the CSRs “Which of the 3 options should you choose for Donna’s
Notes
situation?”
• Donna wants coverage for herself and her family members.
• Donna and her husband file their taxes jointly, so this is not a multi-tax
household.
INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been
publicly disclosed and may be privileged and confidential. It is for internal government use only and must not be
disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure
may result in prosecution to the full extent of the law.
9
Consumer Eligibility and Enrollment Call-Flow Wrap-Up
Instructor Guide
Getting Started — continued
Item
Description
Suggested 1. Tell Donna you are on a screen that asks if she would like to find out whether
Activities
she can get help paying for health coverage.
SCREEN 14 2. Review the radio button options with her.
3. Make the selection she chooses.
4. Select the SAVE & CONTINUE button.
Instructor • Donna reconfirms she would like to find out if she can get help paying for
Notes
health coverage.
Suggested 1. Ask Donna how many people in her household she would like health coverage
Activities
for.
SCREEN 15 2. Enter 5 in the space provided.
3. Select the SAVE & CONTINUE button.
Instructor • Begin the application.
Notes
• Donna is applying for 5 people.
Suggested 1. Using the EDIT and REMOVE buttons, enter the name, date of birth, and
Activities
relationship of each family member for Donna.
SCREEN 16 2. Select the ADD ANOTHER PERSON button, as needed.
3. Select the SAVE & CONTINUE button.
Instructor • Donna: 07/01/1976, applicant
Notes
• Raymond: 10/15/1974, husband
• Matteo: 05/15/2002, son
• Brittany: 01/28/2000, daughter
• Tomas: 06/2/1997, son
INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been
publicly disclosed and may be privileged and confidential. It is for internal government use only and must not be
disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure
may result in prosecution to the full extent of the law.
10
Consumer Eligibility and Enrollment Call-Flow Wrap-Up
Instructor Guide
Family and Household
Item
Suggested
Activities
SCREEN 17
Instructor
Notes
Description
1. Let Donna know you are beginning the Family & Household section of the
application. Read the information on the screen to her.
2. Select the NEXT button.
• Begin the Family & Household section of the application.
Suggested
Activities
SCREEN 18
Instructor
Notes
1. Enter each family member’s Social Security number (SSN).
2. Select the Yes radio button for each SSN entered.
•
•
•
•
•
•
1.
2.
Donna: ###-##-####
Raymond: ###-##-####
Matteo: ###-##-####
Brittany: ###-##-####
Tomas: ###-##-####
Names given are the same names that appear on each Social Security card.
Ask Donna if each family member is a U.S. citizen or U.S. national.
Select the Yes radio button for each family member.
1.
2.
3.
•
•
Ask all tax and household questions.
Select the appropriate radio button next to each question.
Select the SAVE & CONTINUE button.
Donna and Raymond do plan to file a joint tax return for 2013.
The children will be claimed as dependents on Donna and Raymond’s tax
return for 2013.
Suggested
Activities
SCREEN 19
Instructor • Each family member is a U.S. citizen.
Notes
Suggested
Activities
SCREEN 20
Instructor
Notes
Suggested
1. Donna and Raymond have 3 children under the age of 19.
Activities
2. Select the SAVE & CONTINUE button.
SCREEN 21
Instructor • Donna and Raymond have 3 children for whom they are the primary
Notes
caregivers.
Suggested 1. Ask Donna if she is of Hispanic, Latino, or Spanish origin. Enter Yes or No,
Activities
according to her response.
SCREEN 22 2. Ask Donna what her race is. Select the response she gives.
3. Select the SAVE & CONTINUE button.
Instructor • The consumer’s responses to these questions are optional.
Notes
INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been
publicly disclosed and may be privileged and confidential. It is for internal government use only and must not be
disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure
may result in prosecution to the full extent of the law.
11
Consumer Eligibility and Enrollment Call-Flow Wrap-Up
Instructor Guide
Family and Household — continued
Item
Description
Suggested 1. Ask Donna if anyone in her family has a disability or needs help with the
Activities
activities of daily living.
SCREEN 23 2. Select the None of these people check box.
3. Select the SAVE & CONTINUE button.
Instructor • No one in Donna’s family is in this situation.
Notes
Suggested 1. Ask Donna if anyone in her family is an American Indian or Alaska Native.
Activities
2. Select the None of these people check box.
SCREEN 24 3. Select the SAVE & CONTINUE button.
Instructor • No one in Donna’s family is an American Indian or Alaska Native.
Notes
• Note that the Marketplace Online Application is a dynamic tool that displays
questions based on the consumer’s previous responses. The consumer may
not be asked this question or the remaining questions in this section,
depending on their answers to previous questions.
Suggested 1. Ask if anyone in Donna’s household is pregnant.
Activities
2. Select the None of these people check box.
SCREEN 25 3. Select the SAVE & CONTINUE button.
Instructor
• The consumer’s response to this question is optional.
Notes
• No one is pregnant.
Suggested 1. Review family and household information with Donna.
Activities
2. Select the SAVE & CONTINUE button.
SCREEN 26
Instructor • Everything is accurate on the Summary screen.
Notes
• Have the CSRs repeat this process, as needed, for other household members.
INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been
publicly disclosed and may be privileged and confidential. It is for internal government use only and must not be
disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure
may result in prosecution to the full extent of the law.
12
Consumer Eligibility and Enrollment Call-Flow Wrap-Up
Instructor Guide
Income
Item
Suggested
Activities
SCREEN 27
Instructor
Notes
Description
1. Tell Donna she may need pay stubs, W-2 forms, and information about other
income she and her family may receive.
2. Select the NEXT button.
• Donna has brought everything she needs to the conversation.
• Begin the Income section.
Suggested
Activities
SCREEN 28
Instructor
Notes
Suggested
Activities
SCREEN 29
1.
2.
3.
•
Ask Donna if she has any of the income listed on the screen.
Select the YES radio button.
Select the SAVE & CONTINUE button.
Donna has a job.
1. Confirm Donna’s income is from a job and select that from the What type of
income would you like to add? field.
2. Ask Donna the name of her employer and enter that information in the Name
of employer field.
3. Enter the amount of her annual income.
4. Select how often she gets that amount.
5. Select the SAVE button.
Instructor • Donna works at The Floral Arrangement Flower Shop.
Notes
• She makes $20,004.00.
• She is paid $1667.00 monthly.
• She will need to repeat this process for Raymond who makes $27,000 a year.
Suggested 1. Ask Donna if she pays for alimony, student loan interest, or any other type of
Activities
deductions.
SCREEN 30 2. Select the No radio button.
3. Select the SAVE & CONTINUE button.
Instructor • You will have to repeat these questions for each member of the household.
Notes
Suggested 1. Ask Donna if she expects her household yearly income to be the same as what
Activities
is shown on the screen.
SCREEN 31 2. Select the Yes radio button.
3. Select the SAVE & CONTINUE button.
Instructor • All income will be the same.
Notes
Suggested 1. Ask Donna to confirm her monthly income is the amount shown.
Activities
2. Select the SAVE & CONTINUE button.
SCREEN 32
INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been
publicly disclosed and may be privileged and confidential. It is for internal government use only and must not be
disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure
may result in prosecution to the full extent of the law.
13
Consumer Eligibility and Enrollment Call-Flow Wrap-Up
Instructor Guide
Income — continued
Item
Instructor
Notes
Suggested
Activities
SCREEN 33
Instructor
Notes
Description
• Income summary screen
1. Review and confirm all information for Donna and Raymond.
2. Select the SAVE & CONTINUE button.
• Everything on the final income screen is accurate according to the information
provided by Donna.
• Additional income information will be requested when completing a family
application. Explain to the CSRs that the Marketplace Online Application will
ask the consumer to complete the income section for each household
member listed on the application.
INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been
publicly disclosed and may be privileged and confidential. It is for internal government use only and must not be
disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure
may result in prosecution to the full extent of the law.
14
Consumer Eligibility and Enrollment Call-Flow Wrap-Up
Instructor Guide
Additional Information
Item
Suggested
Activities
SCREEN 34
Instructor
Notes
Description
1. Introduce the Additional Information section of the application to Donna, and
read her the text on the screen.
2. Select the NEXT button.
• Begin the Additional Information section.
Suggested 1. Ask Donna if she or anyone in her household currently has coverage from the
Activities
list of programs or organizations shown on the screen.
SCREEN 35 2. Select the appropriate check box(es).
3. Select the SAVE & CONTINUE button.
Instructor • No one in Donna’s household has health coverage at this time.
Notes
Suggested 1. Ask Donna if anyone in her household will be eligible for health coverage from
Activities
a job in the following year.
SCREEN 36 2. Select the Yes or No radio button.
3. Select the SAVE & CONTINUE button.
Instructor • No one in the household will be eligible for health coverage from a job.
Notes
• If the answer to this question is yes, the consumer will need to provide
additional information about the job.
INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been
publicly disclosed and may be privileged and confidential. It is for internal government use only and must not be
disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure
may result in prosecution to the full extent of the law.
15
Consumer Eligibility and Enrollment Call-Flow Wrap-Up
Instructor Guide
Review and Sign
Item
Description
Suggested 1. Inform Donna she’s almost finished – she has reached the Review & Sign
Activities
section of the application.
SCREEN 37 2. Read the information on the screen to Donna and let her know you’re about to
review the contents of her application with her.
3. Select the NEXT button.
Instructor • Begin the Review & Sign section.
Notes
Suggested 1. Review all application information on the screen with Donna.
Activities
2. Select the SAVE & CONTINUE button on each screen showing the family
SCREEN 38
member review information.
Instructor • The summary is accurate for each family member.
Notes
• Note for the CSRs the entire application appears for you to review with Donna,
although for the classroom there is only one screen shown.
Suggested 1. Read each statement on the screen to Donna.
Activities
2. Select the Agree radio button next to each statement.
SCREEN 39 3. Select the SAVE & CONTINUE button.
Instructor • Donna agrees to both statements.
Notes
• Ask the CSRs to explain each statement in turn, using plain language.
Suggested 1. Read Donna the information on the Sign & Submit screen.
Activities
2. Ask her to agree or disagree with the statement.
SCREEN 40 3. Enter her full name in the Signature field.
4. Select the SUBMIT APPLICATION button.
Instructor • Donna agrees with the statement on the screen.
Notes
• Donna’s application is submitted.
INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been
publicly disclosed and may be privileged and confidential. It is for internal government use only and must not be
disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure
may result in prosecution to the full extent of the law.
16
Consumer Eligibility and Enrollment Call-Flow Wrap-Up
Instructor Guide
PART 3: TELL THE PRICE FAMILY ABOUT THEIR ELIGIBILITY
Item
Suggested
Activities
SCREENS
1-6
Instructor
Notes
Suggested
Activities
Instructor
Notes
Suggested
Activities
SCREENS
5-6
Instructor
Notes
Description
1. Share the good news that, based on the information she provided, Donna and
her family are not only eligible to enroll in a plan in the Marketplace, but they
are also eligible for an advance premium tax credit (APTC), the Children’s
Health Insurance Program (CHIP), and cost-sharing reductions.
• The screenshots in this section are sections of a large, scrolling screen for
eligibility results.
• Eligibility results from the online application are displayed in a PDF document.
• The Marketplace has determined the Price family is eligible for the APTC, CHIP,
and cost-sharing reductions.
1. Based on the annual household income Donna provided, she is not eligible for
Medicaid, but the other programs for which her family is eligible will help
lower costs to get coverage for her entire family.
2. All of Donna’s children can be covered under CHIP. The Marketplace will
inform the CHIP agency in Texas so Donna’s children can begin receiving
coverage immediately. The Texas CHIP office number is: 1-877-541-7905.
3. Because Donna is eligible for the APTC, her premiums can be discounted up to
$601 per month. She will decide how much of the $601 per month will go
towards her premiums when she is choosing coverage.
4. Once Donna decides how she will apply her lower costs, she can move on to
the next step in the application process: plan compare and selection.
• Donna wants to know if she is eligible for Medicaid.
1. Ask if anyone in Donna’s household wants to register to vote.
2. Select the CONTINUE TO ENROLLMENT button.
• Donna and Raymond are both registered voters.
INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been
publicly disclosed and may be privileged and confidential. It is for internal government use only and must not be
disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure
may result in prosecution to the full extent of the law.
17
Consumer Eligibility and Enrollment Call-Flow Wrap-Up
Instructor Guide
PART 4: HELP THE PRICE FAMILY CHOOSE COVERAGE
Item
Suggested
Activities
SCREEN 1
Instructor
Notes
Suggested
Activities
SCREEN 2
Suggested
Activities
SCREEN 3
Instructor
Notes
Suggested
Activities
SCREEN 4
Instructor
Notes
Suggested
Activities
SCREEN 5
Instructor
Notes
Suggested
Activities
SCREEN 6
Instructor
Notes
Suggested
Activities
SCREEN 7
Description
1. Review the Enroll To-Do List screen with Donna.
2. Select the first green SET button.
• Donna would like to know all of her options for using her lower costs.
1. On the Decide how much of your premium tax credit to use each month
screen, select the CONTINUE button.
1. In the Review the 3 ways that you can use your premium tax credit screen,
review the information with Donna. See if she has any questions.
2. Select the I HAVE REVIEWED button.
• Donna confirms she understands the information.
1. Ask Donna whether she wants to use her entire tax credit, or some amount per
month that is less than the full amount.
2. Select the NO button.
• Donna would like to use all of her tax credit each month. She does NOT want
to use less than the full amount.
1. Review and confirm the tax credit amount Donna would like to use each
month.
2. Select the CONFIRM YOUR TAX CREDIT AMOUNT button.
• This is the final screen for determining how Donna wants to use her lower
costs.
1. In the Enroll To-Do List screen, select the next green SET button in the Answer
questions about your household row.
• Help Donna set up her health plan shopping preferences.
1. Ask Donna whether anyone in her household smokes, and select the
appropriate radio button for each person, including Donna.
2. If there are smokers in the household, answer this question for all smokers in
the household: If yes, when was the last time you used tobacco regularly?
3. Select the CONTINUE button.
INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been
publicly disclosed and may be privileged and confidential. It is for internal government use only and must not be
disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure
may result in prosecution to the full extent of the law.
18
Consumer Eligibility and Enrollment Call-Flow Wrap-Up
Instructor Guide
Help the Price Family Choose Coverage — continued
Item
Instructor
Notes
Suggested
Activities
SCREEN 8
Instructor
Notes
Suggested
Activities
SCREEN 9
Suggested
Activities
SCREEN 10
Instructor
Notes
Description
• No one in Donna’s household uses tobacco.
• The tobacco use question is here because health insurance companies are
allowed to charge tobacco users higher premiums. The premium for a tobacco
user may be up to 1.5 times higher than the premium a nonsmoker pays.
1. Ensure Donna and Raymond will be in one group and on one plan.
2. Select the USE THESE GROUPS button.
• Donna and Raymond will be grouped together.
• The children will be in a separate group (not in a group with Donna and
Raymond) because they will be covered by CHIP.
1. In the Enroll To-Do List screen, select the next green SET button in the Select a
health insurance plan 1 (Donna and Raymond) row.
1.
2.
3.
•
•
Explain there are 3 things to know about these plans.
Describe essential health benefits.
Select the NEXT button.
Donna needs to understand essential health benefits.
This screen reminds Donna that all plans provide the same set of essential
health benefits. Some plans may offer additional benefits or expanded
coverage.
1. Describe what happens if there is a lower or higher premium.
2. Select the NEXT button.
Suggested
Activities
SCREEN 11
Instructor • Donna needs to understand what happens to her out-of-pocket costs if there is
Notes
a lower premium.
• Explain the relationship between premiums and out-of-pocket costs. In
general, the lower the premium, the higher the group’s out-of-pocket costs for
care will be. The higher the premium, the lower the group’s out-of-pocket
costs for care will be.
Suggested 1. Describe the 4 plan categories to Donna.
Activities
2. Select the NEXT button.
SCREEN 12
Instructor • Donna confirms she understands the 4 plan levels.
Notes
INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been
publicly disclosed and may be privileged and confidential. It is for internal government use only and must not be
disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure
may result in prosecution to the full extent of the law.
19
Consumer Eligibility and Enrollment Call-Flow Wrap-Up
Instructor Guide
Help the Price Family Choose Coverage — continued
Item
Description
Suggested 1. Describe the Select a plan category below screen to Donna.
Activities
a. Number of plans per level available
SCREEN 13
b. High and low premium ranges
c. Average copayment
d. Average deductibles
e. Average out-of-pocket maximums
2. Select the check box above the Bronze column.
3. Select the VIEW SELECTION button.
Instructor • Donna would like to know how many bronze plans are offered.
Notes
Suggested 1. Review the plans in the Health plans screen with Donna.
Activities
SCREEN 14
Instructor • Donna would like information about her plan options in the bronze category.
Notes
Suggested
Activities
SCREEN 15
Instructor
Notes
1.
2.
3.
•
•
•
•
Suggested 1.
Activities
2.
SCREEN 16 3.
Instructor •
Notes
•
Select the Compare box next to each plan Donna wishes to compare.
Select the Compare Plans button in the upper right corner.
You may select as many plans as needed to compare on behalf of Donna.
Donna would like to compare her plan options.
Ask Donna what information is most important to helping her compare plans.
How do these screen elements align to the 3 Cs: Cost, Coverage, and
Convenience?
What information here will be most useful to Donna as she compares plans?
View 3 plans at a time, side-by-side.
Page forward or backward by selecting the arrows in the upper right corner.
Describe the plan that has the lowest monthly premium.
Donna would like to know which plan has the lowest monthly premium.
Explain this screen will help determine the types of plans that fit Donna’s
household needs based on such criteria as the following:
o Plan level
o Monthly premium range
o Copayment
o Deductible
o Out-of-pocket maximum
INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been
publicly disclosed and may be privileged and confidential. It is for internal government use only and must not be
disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure
may result in prosecution to the full extent of the law.
20
Consumer Eligibility and Enrollment Call-Flow Wrap-Up
Instructor Guide
Help the Price Family Choose Coverage — continued
Item
Description
Suggested 1. Read the plan details and select the ENROLL button to the right of the plan
Activities
name.
SCREEN 17
Instructor • Donna would like to enroll in that option.
Notes
• Use the filters on the left of this screen to reduce the number of plans in the
list. You can view additional details about each plan by hovering over the plan
name or selecting the DETAILS button.
Suggested 1. After confirming with Donna on the Confirm your health plan selection popActivities
up screen, select the CONFIRM button again to confirm her selection.
SCREEN 18 2. Review and confirm Donna’s selection restating the monthly premium.
Instructor • Donna asks to review the monthly premium once more.
Notes
Suggested 1. In the Enroll To-Do List screen, select the green SET button in the Set up your
Activities
dental preferences (Optional) row.
SCREEN 19
Instructor • Donna confirms she and Raymond want to get dental coverage.
Notes
Suggested 1. On the Are you interested in separate dental coverage? screen, select the
Activities
check boxes for Donna’s and Raymond’s names.
SCREEN 20 2. Select the CONTINUE button.
Instructor • The health plan Donna chose does not offer dental coverage.
Notes
• Confirm she would still like to add dental coverage under a separate plan.
Suggested 1. In the Enroll To-Do List screen, select the green SET button in the Select a
Activities
dental plan (Donna and Raymond) (Optional) row.
SCREEN 21
Suggested 1. In the You wanted Dental for Donna and Raymond screen, ask Donna to
Activities
confirm both she and Raymond want dental coverage.
SCREEN 22 2. Select the checkboxes for each of them.
3. Select the CONTINUE button.
Instructor • Donna confirms again she and her husband both want dental coverage.
Notes
Suggested 1. In the How many dental plans do you want? screen, select the drop-downs so
Activities
both Donna and Raymond are in single group to get dental coverage.
SCREEN 23 2. Select the USE THESE GROUPS button.
Instructor • Donna confirms she and Raymond want to be on the same dental plan.
Notes
INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been
publicly disclosed and may be privileged and confidential. It is for internal government use only and must not be
disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure
may result in prosecution to the full extent of the law.
21
Consumer Eligibility and Enrollment Call-Flow Wrap-Up
Instructor Guide
Help the Price Family Choose Coverage — continued
Item
Suggested
Activities
SCREEN 24
Instructor
Notes
Suggested
Activities
SCREEN 25
Instructor
Notes
Suggested
Activities
SCREEN 26
Instructor
Notes
Suggested
Activities
SCREEN 27
Instructor
Notes
Suggested
Activities
SCREEN 28
Suggested
Activities
SCREEN 29
Instructor
Notes
Suggested
Activities
SCREEN 30
Instructor
Notes
Suggested
Activities
SCREEN 31
Description
1. Read the names and information for the dental plans available to Donna.
• Donna would like to know the names of all the plans offered.
1. Use the Premium range filter at the left side of the screen to show a more
limited range of plans with lower premiums.
2. Review information about each plan with Donna.
• Donna would like to know which options have the lowest monthly premiums.
1. Select the ENROLL button for Donna’s preferred plan.
• Donna would like to enroll in the first option described to her.
1. Read and confirm Donna’s dental plan selection.
2. Select the CONFIRM button.
• Donna is happy with her choice.
1. In the Enroll To-Do List screen with Donna, select the green SET button in the
Review and confirm your coverage row.
1. Read Donna the Premium Tax Credit Attestations.
2. Select the I Agree button.
• Donna agrees to the Premium Tax Credit Attestations.
1. Review and confirm Donna’s health and dental plan choices.
2. Select the CONFIRM button.
• Donna confirms her plan choice.
1. Read the congratulations statement to Donna.
2. Explain you cannot accept or submit payments on Donna’s behalf. Donna must
pay the health insurance company directly.
INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been
publicly disclosed and may be privileged and confidential. It is for internal government use only and must not be
disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure
may result in prosecution to the full extent of the law.
22
Consumer Eligibility and Enrollment Call-Flow Wrap-Up
Instructor Guide
Help the Price Family Choose Coverage — continued
Item
Instructor
Notes
Description
• Donna is ready to pay her first month’s premium to ensure her coverage will
begin next month.
• Give Donna the contact information for the insurance company from this
screen. Each company’s name, phone number, and mailing address appear in
the bottom-right corner of the plan it provides.
• There is a 48 - 72 hour timeframe for the insurance company to receive and
process Donna’s enrollment.
• Donna can still change her family’s enrollment during the open enrollment
period, up until coverage begins.
INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been
publicly disclosed and may be privileged and confidential. It is for internal government use only and must not be
disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure
may result in prosecution to the full extent of the law.
23
Consumer Eligibility and Enrollment Call-Flow Wrap-Up
Instructor Guide
PART 5: HELP THE PRICE FAMILY ENROLL AND PAY FOR
COVERAGE
Item
Suggested
Activities
SCREENS
93-96
Instructor
Notes
Description
1. Tell Donna her new health insurance company will send her plan materials,
and inform her when and how to make premium payments.
2. Tell Donna it’s the insurance company’s responsibility to confirm her
enrollment and take payments.
3. If Donna has any questions or problems with her new health coverage, she
must contact the health insurance company’s customer service department.
• There are no screenshots for this section.
• Donna is now enrolled and wants to pay her first month’s premium.
INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been
publicly disclosed and may be privileged and confidential. It is for internal government use only and must not be
disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure
may result in prosecution to the full extent of the law.
24
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