health care plans 2016

what i'm going to walk through today is a live 2016 application in one of our test environments. and i'm going to point out some of the new features that we've added this year and then i'll also kind of talk about some of the other things that we won't necessarily have time to walk through with everyone but we'll certainly be in training materials that we'll post on martketplace.cms.gov later this -- well i guess it's friday, [laughs] so probably this weekend or next week. and again, of course, if you have questions as i go please feel free to enter them into the chat window and then we'll try to go through the

questions at the end after i finish walking through everything. i went ahead and pre-setup some accounts so i went ahead and did [unintelligible] to save a little bit of time and i'm going to start with a brand new consumer for 2016 applying for this year. i'm going to start with logging in. and one of the new things that we did add this year is a lot more tailored contents for consumers when they first log in depending on the phase that they're in. one of the other new things that we did is we actually updated the content of the major call to action on the welcome page for both new and

re-enrolling consumers. this used to say "visit the marketplace for individuals and families" this year we re-labeled it "to start a new application or update an existing application." in some of the consumer testing that we were doing leading up to this open enrollment period we found that re-enrolling consumers were a little bit confused by this before with the prior content. they weren't sure it was actually for them so we actually tested some different pieces of content and this way we're hoping that it calls out to both new people as well as people that are coming back just to update their information to stay covered for

2016 and it also is evergreen throughout the year if they're coming back to report a life change later in the year. this next page that says "need coverage for 2016" at the top is one of our new guiding pages. it has tailored content on it, depending on your consumer scenario. so a new consumer that logs in for the first time beginning on sunday, when open enrollment launches, will see a page that looks like this. that sets the framework for what are they going need to do. they're going to need to: (1) complete a 2016 application; (2) view their eligibility results; and then (3) choose a plan by december

15th if they want coverage that begins january 1. and then we'll ask for the consumer's state. this content also changes as we get past different enrollment deadlines, so right now we're letting consumers know that december 15th is the deadline if they want their coverage to start by january 1st. this stage will have a minor content update, one for past december 15th to remind consumers that open enrollment will end on january 31st so that they know up front when they actually need to complete enrollment by. and then i will, at the very end, i'll come back and log in to a couple other accounts i pre-set up. this page is

tailored for re-enrollees as well that recognizes the fact that they're coming back in and welcomes them and sets a slightly different frame for them about what their experience will be, such as updating their application, viewing their updated eligibility results, and then picking a plan, again, with the same deadline reminder messaging. i'm going to go ahead and start my application. and again, for brand new consumer they would actually go through i.d. proofing first, which i went ahead and set up so that we could save some time as we were walking through this. there aren't any changes to that process this year, so

for those of you who might have been around for last year's open enrollment or our first launching year, it is the same screens that we walked through previously and i believe that we already have training materials out there on that as well if you have questions. so getting started, when you're a brand new consumer we have a quick couple of questions that we want to know what your situation is. i'm going to use the scenario for a parent with one child so that we can see some mixed eligibility when i get to the end so that we actually have a family that will receive qhp eligibility, appc eligibility, and then

we'll have one family member that's also met -- eligible for medicaid or chip. and these couple of questions in the beginning help us figure out if the consumer scenario can go through our streamlined application user interface or will go for a classic application user interface. for this new scenario i'm going to use -- assess where we can actually go through the streamlined application so we can point out how that has changed this year. and then if we still have time left i'll do a quick run through of the classic application on a re-enrollee just so that you can kind of see the differences between the two and where we've added

different help text and some new questions this year. and -- sorry i'm catching up on myself, answering my questions [laughs]. we summarize all of these questions at the end of the application for everybody and i'm just going to quickly go through these so i can get into the actual application. and on the first application screen, this is pretty populated with the information that john carson [spelled phonetically], who is our primary application contact provided when he actually went through identify proofing, so that's why the email address, the phone number, is already

populated. and for sisters, this question right here underneath household contact information for another person that's helping me complete my application, this is an important checkbox to check because this is where you would actually put in your information if you're working with a consumer. i'm going to uncheck this box since i am working through this myself right now. and a mailing address, again, is already populated from my identity proofing questions. i'm going to go ahead and put in my test case social security number because i didn't do that originally when i i.d. proofed, but for most consumers you would

have already put that in. and for race/ethnicity, these are completely optional questions. do make sure when you're going through with consumers that who's applying for coverage question is answered either yes or no. that helps us figure out who in the household leader needs coverage. so i'm going to start entering in john's spouse, who's suzanne carson [spelled] phonetically] and her date of birth, her social security number, and then i'll also enter in their child's information, which will be anna carson [spelled phonetically]. and i am asking for coverage for suzanne

and anna, their youngest child who is 10. and anna's social security number. right after we do basic contact information when you're using the streamlined application in the back end we're verifying some of the information as we go. so then i have kind of a progress bar that anna makes on the application button just to let them know what's happening in the background before they get the next stage of questions. so as we're submitting household contact information, that -- that data that they entered in has been saved. next up is that we actually ask for income information. for the

scenario i'm running through today, this is a pretty simple scenario that i've loaded up just so that we can make sure we get through everything today. but the one thing i will point out in one second is for folks that don't have a constant stream of income, there's a way to help the consumer estimate what that is. and i'll show you how to do that when i have suzanne's information and under yearly income i'm just verifying that that's in total what john thinks he's going to have for his income for the year. for suzanne, i'm going to enter in her job. and she's going to make about the same so that i can have a scenario

that comes out with mixed household eligibility. just for purposes of running through. and if she makes about the same amount of money per year we should have a household that makes about $32,000. however, if you have consumers that don't necessarily earn a steady income, you would want to make sure you add each source of income that they do know about and the amounts for each one and how often they receive it, depending on the type. for those that don't have steady income, when you get to this yearly income for each person this hover will let you know what to do. it

actually says "click no if your income for the year won't be the addition of everything that you've entered above." when you click "no," underneath that based on what you know today, you think suzanne's going to make about the $16,000, if you click on "i don't know, help me estimate my yearly income" this brings up a calendar view for those consumers that don't have steady month-to-months and i'll just type in numbers here so you can see it just starts to add up, so consumers that need help estimating it for unsteady income this is a quick and easy way that you can help them do that on-screen. but for this scenario i have

suzanne as having $16,000 for the year. anna, their daughter, does not have any income so i don't need to add any sources and i'm going to say yes for her total income being zero. the next set of -- oops, sorry i missed one as i was talking. for suzanne, her hours worked. the next set of questions that loads helps up identify consumers that might be eligible for medicaid due to non-income based reasons. so there are three questions in the application that ask about physical disability and mental health. if people have additional assistance with daily living activities or if

they need help paying for their medical bills for the prior three months. these questions help us flag consumers that may want to seek a determination or review with their state medicaid office to see if they may qualify for reasons other than income. our determinations are based on income at this point in time but we ask those questions so that hopefully we can get the most amount of consumers into the right program that best meets their needs given their situation. if any consumers do have other health coverage, if you say yes here, this is for consumers that have a family member that has medicaid or chip in particular in

their particular state or any of these other health insurance programs is where they answer. otherwise you would say "no" if they don't have health coverage through any other programs. and under our additional coverage options, we also have this question, if anybody was recently denied eligibility for medicaid or chip. this is a question that would be important to answer here so that we don't send them back through the same door through this application process, and if they do select a person, they'll ask you the date and who. for my scenario i'm not going to say anybody was denied so that we can

actually have eligibility come out with one person that's eligibility for medicaid. questions about life changes are commonly what we use to help figure out seps for common scenarios that are granted through the application for special enrollment periods. since we're in 2016 open enrollment, i'm not going to answer any of these, but there could be scenarios where somebody has experienced a special enrollment period event. in which case that would still grant a special enrollment period that could last longer than open enrollment, particularly if we get into january. so

it's important to review this information with your clients as they come in. and for our renewal of coverage question, this just asks whether they're -- that they will allow the marketplace in a future year to tax data which helps with auto enrollment and re-enrollment each year. and whether we can automatically ping to try to see if their income has changed, know what they might be eligible for in the future year. this last question, the tax filer attestation is one the new questions that we've added this year. everybody will see it on all applications for 2016. we want to make sure that we don't miss anybody. it is only

really relevant for those consumers that had marketplace coverage and received premium tax credits in 2014. if they did, we've wanting to know if they reconciled this premium tax credit on their 2014 tax return yet. if they haven't yet, then we have a lot of messaging we've been doing a lot of pushing before open enrollment and will continue to reach out to those folks during open enrollment to try to make sure that they reconcile their taxes with irs and come back to tell us that they've done that. this question helps us help them to stay covered for january with tax credits if they just filed but maybe the records at irs have

not caught up with that yet. for most consumers that are brand new, this obviously wouldn't apply to them, so they have nothing to check or answer on this question. "review my application" is going to take us to a summary of all the information the consumer has put in so far. with the ability to edit any one of these sections, it'll take you back to the page where this information was entered and then you can actually correct any type-o's or adjust information as needed before submitting it for an eligibility determination. as we get into the bottom of these household questions

some of these are the questions that we ask at the very, very front when we were working to figure out are they going to go through the streamlined application user interface, which this scenario is walking through. or if they went through classic application they see a different application review but it does the same thing where it puts together all the questions and the answers that the consumer provided so they can verify the information before submitting it for an eligibility determination. at the very end of the review our attestations again for agreeing and

confirming if anybody ends up eligible and enrolls in medicaid, it's stating that they know they need to come back and contact the marketplace. there are other rules and regulations that govern how those two programs interact with each other, which is most of what the attestations and the help text here explain. and then at the very end before signing and submitting, we electronically type in our name. so for this scenario it's john carson. and as we submit the application, again, you can see that there's a progress bar on this application that lets the consumer know that it's processing and kind of what's going on

behind the scenes before they get to their eligibility results. so as we get to the very end of our processing, you should see -- i'm sorry, i'm letting the webinar catch up -- a check mark saying it was submitted. and then we're going to land on our new eligibility results page. this is one of the improvements this year that we've internally been very excited about. this has high level on-screen eligibility results displayed for consumers. so for those of you who've been working in the field with us for a while, you're probably well aware our previous

eligibility results screen just had a link to download their eligibility determination notice and then a button to continue to enrollment if they were eligible. what we've been able to add this year is an onscreen summary of their program level eligibility so we can see anna carson here is eligible for medicaid and then john and suzanne, since they share eligibility are grouped together in a box and we can see that the two of them are eligible to purchase a qhp, they both have $653 a month in premium tax credits that they can apply to their premiums. we can also see that these consumers are eligible for cautionary reductions on

silver plans. so this is one thing that's really important to help highlight for those consumers that are going to be eligible for those cautionary reductions when they get into enrollment that this cautionary reductions apply to silver plan choices and not necessarily other metal levels. the other big new feature here is this red text for temporary eligibility. this is our onscreen flag to let the consumers know that there is an inconsistency or a data matching issue and that they have roughly three months to resolve it, in -- in the eligibility determination notice they

have the exact number of days, for the onscreen summary we just summarized it to about three months. but we wanted to make sure that this was called out to consumers and was more visible on the screen, and to help them understand that they needed to do something else in order to stay covered. the next piece of information under step 2, "review your eligibility results," this part of the screen will have some dynamic content, depending on what the consumers are eligible for. so in this scenario we have consumers that are eligible for medicaid or chip but we also

have qhp and appc eligible individuals. some consumers, if they're eligible for a special enrollment period, there will actually be text here onscreen that says "you're eligible for special enrollment period" and to read your notice for more details about what the timeline is to enroll during that window. if it's either during open enrollment or if the sep runs longer than open enrollment or for outside of open enrollment, it's just a highlight for consumers to let them know that, hey you do have a special enrollment period, make sure your read your notice to understand your next steps for that.

the next thing we added was a split between viewing eligibility results and the third step for -- to continue to enrollment. for consumers that aren't eligible for qhp coverage, if the whole family was medicaid and chip eligible, they would not see a step 3 here because this "continue to enrollment" heads into our plan selection part of our process for choosing a plan and enrolling. so it is now dynamic so that they don't see the button or be confused by it if they have other eligibility and don't have qhp coverage. we've also disabled this button until consumers have downloaded and viewed their eligibility notice -- and

bear with our quick technology check while i download the file, i know it probably looks white for a second. the pdf notices for eligibility determinations, the examples are posted out on marketplace.cms.gov, but they have a couple of improvements this year, one of which is some improved headings and we moved a lot of the static content that used to be higher up in the notice to the end so that consumers are seeing their next steps and really the dynamic portions that are relevant to them closer to the top of the notice. and then for those consumers that have questions or want to read further

details, some of the other static information has been moved toward the end of that notice. the other key improvement, which we actually launched much earlier this year back in the springtime in the eligibility determination notice is that the notice does include the income amount that the consumer told us that their eligibility determination is based on, so that's just a good key reference to remember as you're walking consumer through applying and enrolling in coverage for 2016. now that i've downloaded by eligibility results, we actually have the ability to continue to enrollment. at this point i'm

going to pause and jump into another scenario before i head into there so that i can make sure it covers some of the newer pieces and then i have a couple of screen shots at the end that just call out the few changes we made in the enrollment funnel. but for the most part that's pretty much been the same. the pause in eligibility results. we do have a couple of targeted content things that i wanted to show folks so as you guys are in the field you're not surprised when these things comes in. when we have consumers that start their application but don't finish, the next time

they log back in they actually will see targeted content recognizing that they started their application but they didn't submit it for results. and that will help remind them of what steps they have left to do before they actually are completely done for enrollment. so this is an account i has started already where i had an application where i had started updating it but i hadn't actually submitted it so i hadn't gotten to eligibility results yet. and, again, we have tailored content for new and for re-enrollees. the messaging there is pretty much the same, which is, you have to finish and submit your application. that's

your first next step. after that reaffirming you need to view your eligibility results and then choose a plan. so this is a dynamic page and it recognizes where they last left off in the process and we'll jump them back into it. and really quick, i'll show you a version where they had submitted their application but they had not enrolled yet. and another account that i had set up just ahead of time. and again, for re-enrollee's the messaging slightly tailored but the core concepts are exactly the same. so, on this page, where the last step is, they've already submitted their application. they've viewed

their eligibility results. the last thing they need to do is choose a plan. our steps come down to just one thing, choose a plan. so that hopefully we can remind consumers that they're not done yet and they have one more step to go before they're ready. and with that, i'm going to switch over to a quick re-enrollee scenario. i'm going to go through this part of the application pretty quickly, so that we can still leave some time for questions at the end. for re-enrolling consumers, they -- some consumers will be able to use the streamline application. some consumers will be using the classic application interface. for this

scenario i'm going to use classic app just so that we can see both sides so that you guys can see some of the differences that show up in both application flows. so for this re-enrollee, when i first logged in, it's recognizing the fact that, hey we already know you're enrolled from 2015, so welcome back. what you need to do now is review and update your 2016 application. submit it, and then you'll see updated eligibility results and then even if you want to stay in the same plan, you still need to choose a plan and enroll by december 15th so that there's not a gap in

coverage. and this also helps us reinforce that updating your application isn't the only step, we want to make sure that this application updates you made get carried over into your enrollment with your plan. so the very last step for re-enrollees is still to actively choose a plan and enroll. even if they want to choose the same plan if it's still available to them. and the button text here changed for re-enrollees from new consumers. this page for new consumers asks them for their state because we didn't know what it was. and the button is called "action let's start my application" for re-enrollee's we're

pre-populating all of their information from their 2015 application, so it's more of a review and update process so we'll see the information already in there and then we can just update and edit the information that may have changed year over year. particularly income, if that might be something that they expect to change for 2016. and for "review and update your application" we can see there's a quick pre-pop summary, pre-population summary of the persons that are on this application. and i'm going to say "update a person's information or add a new person." i want to skip over to our re-enrollment scenario in

classic. so i'm going to go through this very, very fast and we'll catch questions at the end if i need to. so, kind of ignore the questions that i'm answering here because i'm just kind of getting myself out of this flow for demonstration purposes. so we are popping now into a classic application that's been pre-populated from 2015 into 2016. but, again, the consumer's address is already here. if they've moved in the same state, then here they could actually report a change in their address for 2016 coverage. consumers that have moved to a new state in the new year, back on that initial guiding blue page at the

bottom there was a call out to say if you've moved a new state you'll need to start a new application. each application for each state is using eligibility logic rules for that particular state, which is dynamic from state to state. so when consumers move from one state to a new state, they'll actually need to fill out a new application and tell us about that up front rather than trying to change their address in the middle of an application for a different state. as we do address verification -- and again, so in classic application for sisters, you guys are probably well familiar with it, but depending

on your entity type, this is where you'd actually enter in your information when you're helping with an application. and i'm going to flip through a couple of these screens really, really fast just confirming that john carson and his family members. we already have his wife and his daughter on here with their information entered when we get into family and household. again, these answers are already populated. the social security number, if it was already in there and it was clear and it didn't have any issues is hashed out, except for the last four digits. just a reminder, if folks do have an open data matching issue.

particularly on social security number or integration document information, it's important to help those consumers re-enter it and make sure it's accurate this year. one of the new pieces of functionality i will show you that we added earlier this year is i'm going to delete john carson's ssn -- not that you should normally do that, but just to actually demonstrate one of these reminder pop-ups that we added earlier this year. this is relevant for both social security numbers and consumers that have reported eligible integration status. if they haven't entered in all of the information or they try to skip the

question without entering in their social security number, we do have a reminder pop-up to ask if we're sure they want to do that. not providing a social security number if they have one will generate a data matching issue down the road. i will actually skip it for this one so that we can put in a data matching issue, but i just wanted to make sure that you guys could see one of those reminder pop-ups with a consumer tries to continue without that. one of the other new things on the application in the classic realm that i wanted to make sure we flag, this is kind of asked a little bit

differently on the streamlined application but when you're in the classic one, in previous years we know that some consumers would get confused with this question, "does john carson plan to file federal income tax return in 2016 for the next year." for those consumers who don't normally file taxes, sometimes they get confused by this and not realize the impact of saying, "well no i don't normally file taxes so i wouldn't plan to file next year." and not realize that by saying that, that actually makes them ineligible for advanced payments of the premium tax credit. so we added help text on the question to basically help

consumers understand that they don't have to file taxes to apply, but they would need to file if they want to be able to get aptc to help pay for coverage now. and if the consumer selects "no" on this question, this actually pops up additional help information to understand why we're asking this and the implications of that before they get all the to the point of having an eligibility determination that doesn't have qualifications for premium tax credits. so for this scenario i'm going to say yes because we do want the consumer to end up with an aptc determination. but that's just one of the -- the key places we added

some help content to this year that we wanted to make sure folks were aware of. this we do know some consumers have been confused by that question in the past. and as we get into the rest of the family's household information, this is going to look familiar with suzanne and anna. i'm just going to breeze through these screens really fast. since everything's pre-populated already and at this point i don't need to edit any of this information for this year for our scenario. so we have anna's information very quickly. and then at the tail end of our household

section we will have a quick review summary before we do income. and, again, this is just confirming their relationships again to see if any information has changed for this year from last year. and again, these first two questions when we're about this household, these are the same questions that might be able to help us flag for consumers that could be eligible for medicaid for reasons other than income. they are pre-populated from the 2015 application answers. this last question is the question about whether a consumer may have been denied medicaid or chip recently. this is not pre-populated since we're asking about the

last 90 days. so we want to make sure that the answer here is fresh. but i'm going to say none of these people for the scenario we're walking through right now. at the tail end we've got our summary page of all the stuff that we answered in family and household before we go into income. and in our 2015 application we had put in 26 -- or $16,000 so for 2016 it's pre-populating the income that the consumer told us about last year. if a consumer has a different income source, they can add a new one. if they just want to adjust the amount that they expect to earn for 2016

they can select edit and then just update the amount. they can change how frequently they get that amount if they want to or they can add a new source if needed. and they can also remove it if they no longer work at that job or have that source of income they can physically click "remove." so it's more of an edit and update process when you're a re-enrollee coming back in for 2016. and the same thing we'll see for both suzanne and john once we get there -- sorry, suzanne and anna. and just confirming our last pieces, so same thing with suzanne's information i'm going to keep her income the same for this year as last

year and say she doesn't have any new deductions and that it's steady throughout the year. anna didn't have any income and she still doesn't have any income this year. so then we get to our final income summary which just includes all the information that the household has put in for each person and what they earn on a yearly and monthly basis. and lastly in the additional information section, this is where we ask about other coverage if they have other enrollment and other healthcare programs. you can check the box for any one of these for each person we'll ask this. and if any consumer happens to have cobra or job

coverage, there's additional help text here and if they say yes and whether it's to walk through to how to fill out this information if somebody falls into that scenario. in the interest of time i'm just going to breeze through this so that we can get to the end of the re-enrollee scenario so that we can see the updated eligibility results. and now my last coverage, these are our special enrollment period questions again that help us determine if they might be eligible for a special enrollment period based on a recent change such as losing coverage, about to lose coverage, having moved. if somebody recently

gained eligible immigration status and if anybody was recently released from incarceration. at the very end this is the same failed to reconcile ftr attestation questions, which if a consumer had 2014 tax credits and they reconciled them on their federal tax return already, they would simply check this box. since this is a re-enrollee scenario i'm going to go ahead and check it and assume that this household actually had 2014 tax credits. and in our review and sign our classic application again we've got the full list of all of the information that the consumer entered as they were going through so that they can

actually see it. make sure everything is accurate before they submit it for an eligibility determination. lastly we have our attestations these are the same this year as last year and our electronic signature where john is going to type in his name to indicate that he is signing this application. and for re-enrollment the eligibility results page is similar. some of the content is a tiny bit different for re-enrollees but not significantly so. all of the eligibility pieces of information are the same so again we have, since i skipped putting in john carson's social security number

that generated a data matching issue on this application. so we have that flag here that they're going to need to provide more information. we have anna and medicaid, we have the summary for the premium tax credits for their household and the eligibility for cost sharing reductions if they enroll in a silver plan. and again their eligibility results notice would be available for download and until they download it they won't be able to continue to enrollment. so at this point i'm going to pause and pull up just a couple of screens in our plans and pair flow that we can highlight just a couple of the new pieces this

year because we don't quite have time to walk through every piece of re-enrollment. let me switch applications. somewhat of a highlight this year is the updated enrolled to-do list. we have changed the wording on these tasks and the buttons and we also changed the button design here. previously for those of you -- might remember that this had some slightly confusing terminology that used to say "set" on the button and locked on the greet out tasks, which didn't quite resonate with [laughs] the resonate -- with consumers as to what that actually meant and what they'd be doing. so we updated each one to

be clear about what you're going to do for that activity. so if the consumer has eligibility for tax credits in the enrolled to-do list we actually have that first task say "set tax credit." we updated the button design to look like a button to show up in the white bar rather than a whole green block at the end, which some consumers were confused by. they weren't quite sure where to click. and even for the tasks that aren't unlocked yet, that they haven't completed the prior one in order to get to the next one like answer questions here, it still has in the grayed out text what that step will be so they can actually see what

will be coming up next. so this is an example of an un-started enrolled to-do list for a partly completed one. as you're moving through we've also updated the buttons for the edit and change features for each task so that consumers could actually go back. they can still change those but now they actually know what they're editing. and for choosing a health plan, again, we updated the language here so that it didn't just say "set" it actually said "choose a health plan." the last new piece of information in our plan compare enrollment fees for this year is re-enrolling messaging if

their same or similar plan is available to them. so the rest of plan compare, the flow is pretty much the same. there isn't anything else new or special about it this year. the updated to-do list is certainly one of those improvements that we've been looking forward to for a long time. the other thing is for re-enrollees, last year if they wanted to enroll or compare their same plan they needed to have their issuer letter that they received before open enrollment in front of them and that included a 14-digit plan i.d. on it. and the consumer would have had to manually type that number into a search by plan i.d. box on the

left side of the plan compare screen. this year for re-enrollees we have a pop-up message right before they see plan results that lets them know whether their plan is available or not. so this is an example of the one where if their plan is available we're letting them know it's up in a section called "saved plans" which is at the top of the screen. as soon as they hit continue they load as the plan results and then they can go up to the top, hit "saved plans" and check the compare box on that same plan so that -- if it's available. some consumers' plans may not be available to them. that

could be due to the plan not offering the same or similar coverage this year, so there's no plan crosswalk. it's also possible that you may have some consumers where they're no longer eligible to enroll in the plan that they were enrolled in previously based on the enrollment groups that they've set up for this year or the information that's now in their application. in that case they'll actually see a message that says unfortunately your same plan or similar plan isn't available this year, so please take a look, compare, and shop around for coverage that you want for 2016.