Special Enrollment Eligibility

 

Use this user guide to act on a Special Enrollment Eligibility task. Note that a worker can only act on a Special Enrollment Eligibility Task if it has been assigned to him or her.

 

 

 

 

 

From the Home Page access the Admin Dashboard screen. Click the Tasks tab and then, the View My Tasks button.

 

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Special Enrollment tasks are created when a customer answers “Yes” to “Have you had another change in the last 60 days?” on the Special Enrollment Questionnaire. When this happens, the applicants’ eligibility status is updated to “Undetermined”.

 

Special Enrollment tasks are also created if the applicants answer “No” to all questions on the Special Enrollment Questionnaire. In this case, the eligibility status is set to “Ineligible”.

 

In either case, an administrative user can use the special enrollment task to change the applicants’ special enrollment eligibility status.

 

 

 

Process Steps

 

To act on a special enrollment eligibility task:

 

1.      Click on the Tasks tab in the Admin User dashboard.

·        The Tasks tab is displayed.

 

2.      Click the View My Tasks button to only display tasks assigned to you.

 

Tasks that are assigned to you are displayed when you click on the View My Tasks tab. To assign a special enrollment eligibility task to yourself refer to the Assign Tasks user guide.

 

3.      To locate the task, browse the list of tasks or use the search procedure by entering the special enrollment eligibility search criteria:

 

a.      Enter the first name of the primary applicant associated with the special enrollment in the First Name textbox.

 

b.      Enter the middle name of the primary applicant associated with the special enrollment in the Middle Name textbox.

 

c.      Enter last name of the primary applicant associated with the special enrollment in the Last Name textbox.

 

d.      Enter the account holder’s zip code in the Zip Code textbox.

 

e.      Enter the account ID of the account associated with the special enrollment in the Account ID textbox.

 

f.       Select the Special Enrollment from the Type drop-down menu.

 

g.     Select the special enrollment status from the Status drop down menu. Options are:

 

                                                    i.     New

 

                                                   ii.     Review – In Progress

 

                                                  iii.     Re-Open

 

                                                 iv.     Closed – Eligible

 

                                                   v.     Closed – Ineligible

 

h.      Select the special enrollment priority from the Priority drop-down menu. Options are:

 

                                                    i.     High

 

                                                   ii.     Medium

 

                                                  iii.     Low

 

i.       Enter the name of the worker who last acted on the special enrollment in the Name of Worker textbox.

 

j.       Enter the ID of the worker who last acted on the special enrollment in the Worker ID textbox.

 

k.      Check the box(es) to select the Eligibility Results of the account. Options are:

 

                                                    i.     Medicaid

 

                                                   ii.     QHP/APTC/CSR

 

                                                  iii.     Mixed Household

 

                                                 iv.     Not Determined

 

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None of the fields to enter/select search criteria is mandatory; however, at least one must be selected or entered for the search to be completed.

 

 

4.      Click the Search button.

 

·        Special enrollment tasks that match the search criteria are displayed for review. A worker can only act on special enrollment tasks that have been assigned to him/her.

 

5.      Click the Special Enrollment link under the Type column to open the special enrollment task to be acted on.

 

·        The Special Enrollment screen is displayed.

 

6.      Select the radio button to indicate the special eligibility status. Options are: Eligible and Ineligible.

 

7.      Enter the enrollment start date the Start Date textbox in the format MM/DD/YYYY or select it from the calendar.

 

8.      Enter the enrollment start date the End Date textbox in the format MM/DD/YYYY or select it from the calendar.

 

9.      Enter the special enrollment eligibility reason in the Special Enrollment Eligibility Reason textbox.

 

10.   Click tine Override button.

 

11.   Upload supporting documentation for the appeal request, by clicking the Browse button in the Upload Document section, if needed.

 

·        A browse window is displayed to select the documents from local files.

 

12.   Select the document category from the Document Category drop-down menu.

 

13.   Click the Upload button.

 

14.   Click the Return to Dashboard button.

 

·        The Tasks tab of the Admin Dashboard is displayed.

 

Results of the Procedure

 

Special enrollment eligibility is overridden. Once this process has been completed, applicants can access their application and enroll in a plan by going to their dashboard and clicking “Continue where I left off”. The process to notify applicants that they can now complete their enrollment happens outside of the system.