Submit a Special Enrollment Application

 

Use this user guide to apply for healthcare insurance on behalf of an individual outside the open enrollment period.

 

 

 

 

 

From the Home Page access the Admin Dashboard screen.

 

Process Steps

 

To complete a healthcare application on behalf of an individual outside the open enrollment period:

 

1.      Click on the Add an Individual Account button in the Admin User dashboard.

·        The Application Landing Page is displayed.

 

2.      Review the text on the Application Landing Page and the list of documents required to complete the application.

 

3.      Click the Begin button.

 

·        The Create an Account screen is displayed.

 

4.      Enter a username for the primary applicant in the Username textbox.

 

5.      Enter a password for the primary applicant in the Password textbox.

 

6.      Enter user information for the primary applicant:

 

a.      Enter first name in the First Name textbox.

b.      Enter the middle name in the Middle Name textbox.

c.      Enter the last name in the Last Name textbox.

d.      Select suffix from the Suffix drop down menu.

e.      Enter address in the Address Line textbox.

f.       Enter city in the City textbox.

g.     Select State from the State drop down menu.

h.      Enter zip code in the Zip Code textbox.

i.       Enter email address in the Email Address textbox.

j.       Enter phone number in the Phone Number textbox.

k.      Select phone number type from the Phone Number drop-down menu. Options are: Home, Work, Cell and Other.

 

7.      Select three security questions from the drop down menus and enter answers to each question in the Security Questions textboxes.

 

8.      Check the textbox to acknowledge the applicant has read and agreed to the User Acceptance Agreement.

 

9.      Check the textbox to acknowledge the user has agreed to provide Consent for Access Data.

 

10.   Click Next.

 

The Verify Your Identity screen is displayed.

 

11.   Enter the account holder’s date of birth in the Date of Birth textbox in the format MM/DD/YYYY.

 

12.   Enter the account holder’s social security number in the Social Security Number textbox in the format XXX-XX-XXXX.

 

13.   Click Next.

 

·        If the information is not verified, a Referral Code screen, which provides a referral code and the Contact Center number, is displayed.

·        If the information is verified, a second Verify Your Identity screen is displayed with past experience questions that must be answered for the primary applicant.

 

If the identity of the account holder cannot be verified, the user is referred to the Contact Center.

 

14.   Answer the past experience questions by selecting the radio button adjacent to the correct answer.

 

If the questions are not answered correctly, the user is referred to the Contact Center.

 

15.   Click Next.

 

·        The Begin Your Application Screen is displayed.

 

16.   Review the text on the Begin Your Application Screen and click Next.

 

·         Your Information – Who Needs Health Insurance screen is displayed.

 

17.   Select the radio button to indicate if “applicant and members of the household can get help paying for health insurance.”

 

18.   Select from the drop down menu the type of coverage requested:

 

a.      Health Insurance and Dental Insurance

 

b.      Only Health Insurance

 

c.      Only Dental Insurance

 

19.   Enter the number of people, including the primary applicant, living in the household.

 

20.   Click Next.

 

·        The Your Information – Family Members screen is displayed.

 

21.   Enter the following information for each household member for whom assitance is requested in the respective textboxes:

 

a.      Name

 

b.      Date of birth

 

c.      Gender

 

d.      Social Security Number

 

22.   Select the radio button to indicate whether the household member’s gender is Male or Female.

 

23.   Select the radio button to indicate if the member of the household is applying for medical health insurance.

 

24.   Select the radio button to indicate if the member of the household is applying for dental health insurance.

 

 

The information for the primary applicant is pre-populated from the information collected during the login creation and ID proofing.

 

25.   Select the radio button to indicate if the member of the household has a Social Security Number.

 

26.   If the applicant has a Social Security Number, enter it in the Social Security Number textbox.

 

In this screen, members of the household can be added by clicking on the Add a Household Member button. Review the Application – Add a Member user guide for more information about this procedure. 

 

27.   Check the box next to the privacy statement to acknowledge it.

 

28.   Click Next.

 

·        The Apply for Coverage – Your Information screen is displayed.

 

29.   In the Contact Information Section, enter the following information:

 

a.      Primary phone number and type

 

b.      Secondary phone number and type

 

c.      Email address

 

d.      Preferred method and time of contact

 

e.      Preferred languages read and spoken

 

30.   In the Address section, enter:

 

a.      Home address

 

b.      Select the radio button to indicate if the applicant’s mailing address is the same as their home address

 

 

The account holder’s home address is pre-populated for the primary applicant.

 

If there is more than one applicant, the Contact and Personal Information – Secondary Applicant(s) screen is displayed and information for the secondary applicant(s) is entered.

 

 

31.   In the Personal Information section:

 

a.      Select Ethnicity and Race from the drop down menus.

 

b.      Select the radio button to indicate if the applicant is currently incarcerated.

 

c.      Select the radio button to indicate if the applicant is currently pregnant (this question is only displayed for female applicants).

 

32.   In the Citizenship Information section, select the radio button to indicate if the individual is a US citizen or national. If the applicant is not a US citizen or national:

 

a.      Select the radio button to indicate if the applicant has lived in the US for any length of time since 8/22/1996.

 

b.      Select the radio button to indicate if the applicant has an eligible immigration status.

 

33.   In the American Indian/Alaskan Native section, select the radio button to indicate if the individual is an American Indian or Alaskan Native. If the applicant is an American Indian or an Alaskan Native:

 

a.      Select the radio button to indicate if he/she is a member of a federally recognized tribe. If yes, select the name of the tribe from the drop down menu.

 

b.      Select the radio button to indicate if he/she has ever gotten service from Indian Health Service, tribal program, or urban Indian health program.

 

c.      Select the radio button to indicate if he/she is eligible to get services from the Indian Health Service, tribal health programs, or urban Indian health programs through a referral from one of these programs.

 

34.   Click Next.

 

·        The Special Circumstances screen is displayed.

 

35.   In the Disabilities and Disabilities Services section, select the radio button to indicate if the individual is physically ill, incapacitated, blind or disabled. If the applicant has a disability:

 

a.      Select the radio button to indicate if the disability will prevent the applicant from working at least 12 months or result in death.

 

b.      Select the radio button to indicate if the applicant is active with the Office of Rehabilitation Services or Services for the Blind.

 

c.      Select the radio button to indicate if the applicant has applied for SSI or Social Security Benefits (RSDI).

 

36.   In the Disabilities and Disabilities Services section, select the radio button to indicate if the individual needs help with activities of daily living.

 

37.   In the Additional Questions section, select the radio button to indicate if the individual was in the Rhode Island foster care system on his/her 18th birthday.

 

 

If the applicant selects Yes to any of the disability questions, his/her status is updated to “Potentially Eligible for Traditional Medicaid.” The applicant’s name is added to a batch report that is sent to the InRhodes system for complex Medicaid eligibility determination.

 

 

 

 

 

 

 

38.   Click Next.

 

·        The Current Job and Income screen is displayed.

 

39.   In the Current Job and Income section:

 

a.      Select the radio button to indicate if the applicant is currently employed. If yes, an Employer Information section is displayed:

 

                                                    i.     Enter the employer name.

 

                                                   ii.     Enter the employer EIN.

 

                                                  iii.     Enter the employer address.

 

                                                 iv.     Enter the wages/tips before taxes.

 

                                                   v.     Select the frequency of tips.

 

                                                 vi.     Enter the average number of hours worked.

 

To add another employer, click the Add Another Employer button.

 

 

b.      Select the radio button to indicate if the applicant is currently self-employed. If yes, enter the Type of Work and the Net Income for the Past Month in the respective texboxes.

 

40.   In the Other Sources of Income section, select the radio button to indicate if the applicant has other sources of income to report. If the applicant has other sources of income to report:

 

a.      Select the type from the Income Type drop down menu.

 

b.      Enter the amount in the How Much? text box.

 

c.      Select the frequency from the How Often? drop down menu.

 

41.   In the Deductions section, select the radio button to indicate if the applicant has deductions to report. If the applicant has deductions to report:

 

a.      Select the type from the Deduction Type drop down menu.

 

b.      Enter the amount in the How Much? textbox.

 

c.      Select the frequency from the How Often? drop down menu.

 

 

To add additional deductions, click on the Add Another Deduction Type button.

 

42.   If the applicant reported being an American Indian or an Alaskan Native, an American Indian/Alaskan Native Income section is displayed. Select the checkbox(es) to indicate if any of the income reported comes from these sources:

 

a.      Per capita payments from the tribe that came from natural resources, usage rights, leases or royalties

 

b.      Payments from natural resources, farming, ranching, fishing, leases, or royalties from land designated as Indian trust land by the Department of Interior (including reservations and former reservations)

 

c.      Money from selling things that have cultural significance

 

43.   Enter the amount in the How Much? textbox.

 

44.   Select the frequency from the How Often? drop down menu.

 

45.   In the Total Income section, enter the estimated income in the year of coverage, if the applicant does not have a steady income.

 

The income entered in the Current Wages and Tips or the Gross Monthly Self-Employment Income fields is always used to determine eligibility for Medicaid.  Current income is used to determine Medicaid eligibility even if an amount is entered in the Total income field.

 

When an amount is entered in Total income, it is used to determine APTC/CSR eligibility. Current Wages and Tips or the Gross Monthly Self-Employment Income is used to determine APTC/CSR eligibility only when the Total Income field is left blank.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

46.   Click Next.

 

·        The Tax Applicant Information screen is displayed.

 

47.   Select the radio button to indicate if anyone in the household plans to file a Federal tax return next year. If yes, check the box(es) next to the name(s) of the member(s) of the household filing taxes.

 

48.   Select the radio button to indicate if anyone in the household will be a dependent on someone else's return. If yes, check the box(es) next to the name(s) of the member(s) of the household that are on someone else’s tax return.

 

49.   Click Next.

 

·        The Access to Health Coverage screen is displayed.

 

50.   In the Insurance Access section, select the radio button to indicate if the applicant or any members of the household are offered coverage from a job. If coverage is offered, enter:

 

a.      Employer information

 

b.      Enrollment status

 

c.      Indicate who is the employee

 

d.      Employee contribution

 

e.      Name of the plan

 

f.       Employee premium and frequency

 

51.   In the Dental Insurance section, select the radio button to indicate if anyone in the household has access to dental insurance.

 

52.   In the Other Insurance section, select the radio button to indicate if anyone in the household has access to other insurance. If yes, select the appropriate option(s):

 

a.      Veterans Health Insurance

 

b.      CHIP

 

c.      Peace Corps

 

d.      Medicare

 

e.      Private/Other

 

f.       Americorps

 

53.   Click Next.

 

·        The Authorized Representative screen is displayed.

 

54.   Select the radio button to indicate if the applicant has an authorized representative. If the applicant has an authorized representative, enter the representative’s:

 

a.      Name

 

b.      Contact information

 

c.      Contact preferences

 

d.      Language preferences

 

e.      Company name

 

f.       Organization ID

 

55.   Click Next.

 

·        The Application Review screen is displayed.

 

56.   Review the application and click Next.

 

·        The E-Signature screen is displayed.

 

57.   Review the text on the E-Signature screen with the applicant.

 

58.   Ask the applicant or authorized representative to check the box to attest he/she is signing the application.

 

59.   Ask the applicant or authorized representative to enter his name and date in the respective checkboxes.

 

60.   Click Next.

 

·        A screen asking to proceed with the submission is displayed.

 

61.   Click Yes.

 

·        Application Submission Confirmation screen is displayed.

 

62.   Click Next.

 

·        The Application Submission Confirmation screen is displayed. 

 

If the application is not ready for submission, it can be saved and exited. 

 

 

·        The application information is verified against external sources.

 

·        If the application data is not verified, the Provide Additional Explanation/Documentation screen is displayed explaining what is required to complete the application.

 

·        If the application data is verified, the Eligibility Results screen is displayed.

 

63.   Click Continue to proceed to the Your Enrollment Options screen.

 

·        The Your Enrollment Options screen is displayed.

 

The applicant is alerted that the open enrollment period is closed, but they may still qualify to purchase insurance from the Exchange immediately based on special circumstances. The applicant can proceed to the Special Enrollment Questionnaire to determine eligibility for special enrollment or wait until the next open enrollment period –their application is saved in the system for 90 days.

 

64.   Click the See if You Qualify button.

 

·        The Special Conditions screen is displayed.

 

65.   Click the radio button next to the special conditions that apply to you:  

 

a.      Have you or someone in your household lost health coverage within the last 60 days?  If you answered Yes to the question above, enter an answer to the following questions.

 

b.   Has someone in your household lost or will someone lose coverage due to non-payment of a premium?

 

c.   Has someone in your household lost or will lose coverage due to fraud?

 

d.   When was the last day you or your respective household member had health insurance coverage? Enter the date in the format MM/DD/YYYY or select it from the calendar.

 

e.      Have you gained a dependent through marriage in the last 60 days?

 

f.    If you answered Yes to the question above, enter the date of marriage in the format MM/DD/YYYY or select it from the calendar.

 

g.     Have you gained a dependent through birth in the last 60 days?

 

h.      If you answered Yes to the question above, enter the date of birth in the format MM/DD/YYYY or select it from the calendar.

 

i.       Have you gained a dependent through adoption or placement for adoption of a child in the last 60 days?

 

j.       If you answered Yes to the question above, enter the date of adoption in the format MM/DD/YYYY or select it from the calendar.

 

k.      Have you moved to Rhode Island within the last 60 days?

 

l.       If you answered Yes to the question above, enter the date you moved in the format MM/DD/YYYY or select it from the calendar.

 

m.    Has someone in your household had a change in lawful presence or citizenship status within the last 60 days?

 

n.      If you answered Yes to the question above, enter the date of the change in the format MM/DD/YYYY or select it from the calendar.

 

o.      Has someone in your household died in the last 60 days?

 

p.      If you answered Yes to the question above, enter the date of death in the format MM/DD/YYYY or select it from the calendar.

 

q.     Have you had another change in the last 60 days? Please describe below.

 

r.       If you answered Yes to the question above, enter an explanation in the Please Describe Below textbox and enter the date of the change in the format MM/DD/YYYY or select it from the calendar.

 

66.   Click Submit.

 

·        The Special Enrollment Eligibility screen is displayed.

 

If the individual is found ineligible to purchase healthcare insurance outside the open enrollment period, a notification is sent.

 

If the applicant is eligible, a confirmation message is displayed and the application proceeds to plan selection.

 

 

67.   Click Next.

 

·        The Choose a Plan screen is displayed.

 

 

 

Results of the Procedure

 

A special enrollment application is submitted.