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Notice of Benefit and Payment Parameters for 2017:
“… post enrollment and other assistance includes assisting consumers with applying for exemptions from the individual shared responsibility payment that are granted through the Exchange, with understanding the process of filing Exchange appeals, and with understanding basic concepts and rights related to health coverage and how to use it.”
• Health Net recognized the increase of people insured due to ACA, but also an increase in emergency dept. visits
• Insured people were still using the E.D. for primary care
Health insurance ≠ Health Access
• We partnered with local hospitals to change the trend via:• Emergency Dept. Navigators (establish PCP, follow-up care)• Pediatric Health Navigators (establish PCP, follow-up care)• Referrals from hospitals (Kaiser, Dignity, U.C. Davis)
Partner with providers & hospitals to reach new enrollees
1. Make sure the issue is appealable.Common invalid appeals include complaints about the accuracy of tax forms (1095A), issues related to disenrollment/reinstatement related to non-payment of premiums, issues not yet decided by the Marketplace.
2. Provide relevant documentation.Currently, the most time-consuming element of the appeal process is obtaining appeal documentation from consumers.For example, documentation of income is essential in cases involving the award/reinstatement of APTC. Other documents may relate to reasons for exemptions, citizenship/immigration status, or loss of other coverage for SEP cases.
Verification of 2016 Income for Application # _______________ How I earn my money: Example: I am a full-time musician and my income varies month to month. Why my income in 2016 is different from past years: Example: I quit my full-time job in 2014 to become a full-time musician so my income in 2016 will be much lower than in previous years. My estimated income for 2016: (needs to match the amount on the current Marketplace application): Example: My estimated income for 2016 is based on my income from the past two months. Average income of $1,112 per month = $1,112/month x 12 months= $13,344 The attached documents support my estimated income for 2016: (only include documents that clearly support the estimated income): I have attached my self-employment ledger showing my income and expenses for the past 2 months: November profit = $500 December profit = $1,225 Monthly average income (profit) = $1,112 Estimated income for 2016 = $1,112 x 12 = $13,344 I attest that the income information I am submitting is true and accurate. Signature Printed Name & Date