Submit an Electronic Application for Healthcare Assistance
Use this guide to submit an electronic application for healthcare assistance.
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From the Home Page access the Admin Dashboard screen. |
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At any point during the process, the application can be saved and exited by clicking on the Save and Exit button. |
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Incomplete applications are stored in the system for 90 days or for the duration of the open or special enrollment period, whichever is longer. Completed applications yielding eligibility decisions are stored for at least seven years.
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Process Steps
To submit an electornic application for healthcare assistance:
1. Click on the Add an Individual Account link in the Individual Administration section on the Admin Dashboard screen.
· 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 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 and Re-enter Password textboxes.
6. Click <Submit> to create an account.
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Once the username and password are verified, the other sections on this page will be displayed.
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7. 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 1 and Address Line 2 textboxes.
f. Enter the Apt/Unit#.
g. Enter city in the City textbox.
h. Select the state from the State drop-down menu.
i. Enter zip code in the Zip Code textbox.
j. Enter email address in the Email Address textbox.
k. If the applicant does not have a permanent home, select the checkbox I currently do not have a permanent home.
l. Enter the email address in the Email Address textbox.
m. Enter the primary phone number in the Phone Number textbox in the format XXX-XXX-XXXX.
n. Select the type of the phone number from the Phone Number drop-down menu. Options are: Home, Work, Cell and Other.
o. Select the Preferred Time of Contact from the drop-down menu. Options are: Morning, Afternoon, Evening, Weekend, Anytime.
8. Select three security questions from the drop-down menus and enter answers to each question in the Security Questions textboxes.
9. Check the textbox to acknowledge the applicant has read and agreed to the User Acceptance Agreement.
10. Check the textbox to acknowledge the user has agreed to provide Consent for Identity Proofing..
11. In the Enrollment Assistance section, select if you have received assistance in completing this application.
a. Select an option for Who is helping you with the application? from the drop-down menu.
b. Enter information for all other fields in this section.
12. Click <Next>..
· The Verify Your Identity screen is displayed.
13. Enter the account holder’s social security number in the Social Security Number textbox in the format XXX-XX-XXXX.
14. Enter the account holder’s date of birth in the Date of Birth textbox in the format MM/DD/YYYY.
15. 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.
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If the identity of the account holder cannot be verified, the user is referred to the Contact Center. |
16. Answer the past experience questions by selecting the radio button adjacent to the correct answer.
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If the questions are not answered correctly, the user is referred to the Contact Center. |
17. Click <Next>..
· The Begin Your Application Screen is displayed.
18. Review the text on the Begin Your Application Screen and click <Next>..
· Your Information – Who Needs Health Insurance screen is displayed.
19. Select the radio button to indicate if “applicant and members of the household can get help paying for health insurance.”
20. 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
21. Enter the number of people, including the primary applicant, living in the household.
22. Click <Next>..
· The Your Information – Family Members screen is displayed.
23. 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
24. Select the radio button to indicate whether the household member’s gender is Male or Female.
25. Select the radio button to indicate if the member of the household is applying for medical health insurance.
26. Select the radio button to indicate if the member of the household is applying for dental health insurance.
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The information for the primary applicant is prepopulated from the information collected during the login creation and ID proofing. |
27. Select the radio button to indicate if the member of the household has a Social Security Number.
28. If the applicant has a Social Security Number, enter it in the Social Security Number textbox.
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In this screen, members of the household can be added by clicking on the Add a Household Member button. Review the Application – Add a Household Member user guide for more information about this procedure. |
29. Check the box next to the consent statement to acknowledge it.
30. Click <Next>..
· The Apply for Coverage – Your Information screen is displayed.
31. 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
32. 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 his/her home address
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The account holder’s home address is prepopulated for the primary applicant. |
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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. |
33. 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 pregnant (this question is only displayed for female applicants).
34. In the Incarceration Status section, indicate if the applicant is currently incarcerated.
35. 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.
36. 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.
37. Click <Next>..
· The Special Circumstances screen is displayed.
38. 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).
39. In the Disabilities and Disabilities Services section, select the radio button to indicate if the individual needs help with activities of daily living.
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The Disabilities and Disabilities Service section will only be displayed for individuals applying for services. |
40. 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.
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The foster care question will only be displayed for an individual between18 and 26 years of age who is requesting coverage.
If ‘Yes’ is selected to indicate that the individual was in Rhode Island Foster Care on his/her 18th birthday, an information popup is displayed specifying that the person may be eligible for low-cost insurance or Medicaid. You can click <OK> to close the popup and return to Special Circumstances. |
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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. |
41. Click <Next>..
· The Current Job and Income screen is displayed.
42. 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.
b. Select the radio button to indicate if the applicant is currently self-employed. If yes, enter the Loss or Net, Type of Work and the Net Income for the Past Month in the respective texboxes.
c. Click the hyperlink Self Employed Worksheet to enter the details of self-employment.
d. Select the radio button to inidicate if the data above is based on information from documentation/external sources and entered by the worker.
e. If needed, enter additional remarks in the Worker Income Note field. Notes entered are displayed in the Notes History box. Click the View link to read the full text of the existing note(s).
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To add another employer, click the Add Another Employer button. |
43. 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.
44. Select the radio button to indicate if the data above is based on information from documentation/external sources and entered by the worker.
45. 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.
46. 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.
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To add additional deductions, click on the Add Another Deduction Type button. |
47. 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
48. Enter the amount in the How Much? textbox.
49. Select the frequency from the How Often? drop-down menu.
50. In the Total Income section, enter the estimated income in the year of coverage, if the applicant does not have a steady income.
51. Select the radio button to inidicate if the data above is based on information from documentation/external sources and entered by the worker.
52. If needed, enter addiontal remarks in the Worker Income Note field. Notes entered are displayed in the Notes History box. Click the View link to read the full text of the existing note(s).
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53. Click <Next>..
· The Tax Applicant Information screen is displayed.
54. 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.
55. If the primary applicant or anyone in the household are filing taxes next year, select their filing status. Options are:
a. Single filing taxes
b. Married filing taxes separately
c. Married filing taxes jointly
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If you select ‘Married filing taxes separately’, a popup with additional information is displayed. Click <OK> to close the popup and return to Tax Application Information screen. |
56. 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.
57. Click <Next>..
· The Access to Health Coverage screen is displayed.
58. 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
59. In the Dental Insurance section, select the radio button to indicate if anyone in the household has access to dental insurance.
60. 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. RIte Care
c. Peace Corps
d. Medicare
e. Private/Other
f. Americorps
61. Click <Next>..
· The Authorized Representative screen is displayed.
62. 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
63. Click <Next>..
· The Application Review screen is displayed.
64. Review the application and click <Next>..
· The E-Signature screen is displayed.
65. Review the text on the E-Signature screen with the applicant.
66. Read the text on screen to the applicant or the appliant’s authorized representative and check the box to attest he/she is signing the application.
67. Read the text on screen to the applicant or the appliant’s authorized representative and enter his name and date in the respective checkboxes.
68. Click <Next>..
· A screen asking to proceed with the submission is displayed.
69. Click <Yes>..
· Application Submission Confirmation screen is displayed.
70. Click <Next>..
· The Application Submission Confirmation screen is displayed.
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If the application is not ready for submission, it can be saved and exited.
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· 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.
a. Users can upload documents for each household member and each category in the Upload Document section.
· If the application data is verified, the Eligiblity Determination screen is displayed. From here, users can proceed to buy healthcare and dental plans.
71. Review the Plans on the Plan Summary screen and click <Next>.
a. On the Choose a Plan for Current Year screen:
i. From the Left Hand Panel, click the Add Provider button from the Healthcare Providers section.
ii. Search for a Provider screen displays.
72. On the Search for a Provider screen, enter the search criteria:
a. First Name
b. Last Name
c. Facility Name
d. City
e. State
f. Zip
g. Click <Search>.
h. Search Results are displayed in a table.
i. To view additional information about the provider, click the Provider Name hyperlink. Information will be displayed on the Provider Information screen.
73. Select the provider you want to add by selecting the check box next to the provider name and click <Add Provider>.
· The Search for a Provider screen is displayed.
a. Click <Back>.
· The Choose a Plan for Current Year screen is displayed with the selected providers added in the Healthcare Providers section.
74. Click <Go To Dental> to display the Dental Health Insurance plans.
a. Follow steps 71, 72, 73, and 74 to select dental health providers.
b. Click <Next>.
· The Select Your Primary Care Physician screen is displayed.
75. On the Select Your Primary Care Physician screen:
a. For each household member, select the Primary Care Physician from the drop-down options.
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The Primary Care Physician drop-down is populated with the primary care physicians based on the selected provider. In case you want to change the provider, click <Find a Provider>. This will take you to the Search for a Provider screen. |
76. Click <Next> to complete the enrollment.
Results of the Procedure
The application is completed and submitted.
Providers are added to the application and a healthcare plan is selected for the household.
