What is the issue with the consumer's health plan? [[The consumer wants to change plans for 2015. ]] [[Switch from unsubsidized to a subsidized plan for 2015.]] [[Switch from subsidized to an unsubsidized plan for 2015.]] [[Customer wants us to retro terminate.]] [[Update future termination date due to input error.]] [[Terminate their plan.]] [[Change Plan Effective Date between application date and plan start date.]] [[Change Plan Effective Date not between application date and plan start date.]] [[Remove a member from the application.]] [[Consumer wants to update their name, SSN, date of birth for 2014 or 2015.]] [[Mixed household does not want Medi-Cal for 2014 or 2015.]] [[Update consent for verification.]] [[Reinstatement for citizenship.]] [[Adjust APTC amount per month.]] [[Consumer with a household of one or more gained Minimum Essential Coverage (MEC)]]IF: 1. The consumer has selected a plan and/or renewed it. 2. The consumer's plan status is "enrolled." 3. The consumer has made their initial payment. THEN: 1. On the Welcome page, under Actions, click the Change Plan link. 2. On the Change Plan Selection page, click the Change Plan Selection button and assist the consumer with choosing a new plan. 3. Plans changed the 1st – 15th will be effective the 1st of the following month. Plans changed the 16th to the last day of the month will be effective the month after next. NOTES: 1. Once enrolled, the Change Plan link is available. 2. See job aids: Change Change Plan (November 25, 2014), Report a Change, Escalating an Incident Job Aid. IF: 1. The consumer has selected a plan and/or renewed it. 2. The consumer's plan status is "enrolled." 3. The consumer has made their initial payment. THEN: 1. Escalate the CRM incident to a Supervisor. NOTE (this is for supervisors): 1. See job aids: Escalating an Incident Job Aid. 2. Supervisor to request ticket with the following subject line: FIN ASST FLAG: N to Y 3. After the ticket is resolved, Supervisor receives an e-mail. 4. Supervisor or their designee re-determines eligibility to pull the changes. 5. Supervisor or designee performs Report a Change to enter the appropriate fields for subsidized plansIF: 1. The consumer has selected a plan and/or renewed it. 2. The consumer's plan status is "enrolled." 3. The consumer has made their initial payment. THEN: 1. Escalate the CRM incident to a Supervisor. NOTE (this is for supervisors): 1. See job aids: Escalating an Incident Job Aid. 2. Supervisor to request ticket with the following subject line: FIN ASST FLAG: N to Y 3. After the ticket is resolved. Supervisor receives an e-mail. 4. Supervisor or their designee re-determines eligibility to pull the changes.IF: 1. The consumer has selected a plan and/or renewed it. 2. The consumer's plan status is "ENROLLED." 3. The consumer HAS made their initial payment. THEN: Although retro-termination functionality is now available, the only Service Center staff who have permission to use this feature are members of the Health Plan Hotline team, the Customer Resolution Team and the Back Office. SCRs/CSRs/CSAs, if you are not a member of one of the above three groups and receive a call from a consumer that may involve a retro-termination, please contact CRT for assistance. (Contra Costa staff, please follow the escalation process prescribed by your supervisors/managers). -Per Carene's email dated January 30, 2015 at 10:05 AMIF: 1. The consumer has selected a plan and/or renewed it. 2. The consumer's plan status is "ENROLLED." 3. The consumer HAS made their initial payment. THEN: 1. If the retro terminate is regarding one of the following, escalate the CRM incident to a Supervisor: * MEC * Consumer is enrolled in Medi-Cal and has a Covered California plan * Consumer has passed away * Consumer has attempted to terminate, but there was a system failure. NOTE:Supervisor will research and approve the request. Once approved, the Supervisor will be able to perform the retro terminate (CalHEERS r11.2). 2. Otherwise, notify the consumer that unfortunately you cannot assist with the request. NOTES: 1. See job aids: Escalating an Incident Job Aid.FYI: 1. 14 day notice is needed when consumers terminate their plans online. 2. SCRs and CECs can perform same day or future dated terminations. IF: 1. The consumer has selected a plan and/or renewed it. 2. The consumer's plan status is "ENROLLED." 3. The consumer HAS made their initial payment. THEN: 1. Follow Terminate Plan Participation task guide. NOTES: 1. See job aid: Terminate Plan Participation, January 7, 2015. 2. If termination effective date is in the future, the homepage will be in Report a Change mode until it hits the termination effective date. If the Consumer selects a new plan in Report a Change mode, it will also be terminated when the termination effective date is reached. The Consumer will not be able to re-apply until after the termination effective date when the Consumer home page will return to Apply mode.IF: 1. The consumer has selected a plan and/or renewed it. 2. The consumer's plan status is "PENDING." 3. The consumer has NOT made their initial payment. THEN: 1. Escalate the CRM incident to a Supervisor. NOTE (for supervisors): 1. See job aids: Change Plan Effective Dates (Role: Supervisor), Escalating an Incident Job Aid. 2. Plan effective dates can only be modified for consumers with an enrollment status of ‘Pending’ (plan selected, but first payment has not been made).IF: 1. The consumer has selected a plan and/or renewed it. 2. The consumer's plan status is "ENROLLED." 3. The consumer HAS made their initial payment. THEN: 1. SCR must notify consumer that they unfortunately cannot assist with the request. 2. The SCR should inform the consumer to review the notice that contained their original effective, which will contain other options for addressing their issue. NOTE: 1. Plan effective dates can only be modified for consumers with an enrollment status of ‘Pending’ (plan selected, but first payment has not been made).[[Remove primary that is deceased or left household.]] [[Remove non-primary that is deceased with remaining household members for 2014.]] [[Remove non-primary deceased with remaining household members for 2015.]]IF: 1. The consumer has a plan selected. 2. The consumer's enrollment status is "ENROLLED." 3. The consumer HAS made their first payment. THEN: 1. Escalate the CRM incident to a Supervisor. NOTE: Supervisor, external coordination team, or hotline team will do the following: 1. Follow Terminate Plan Participation task guide. 2. Reapply the other household members for 2015, using Open Enrollment with a new case. 3. The primary becomes the Plan subscriber and, in a way, is responsible owner/payer for the plan. Carriers do not support the swapping of planIF: 1. The consumer has selected a plan and/or renewed it. 2. The consumer's plan status is "ENROLLED." 3. The consumer HAS made their initial payment. THEN: 1. Search for consumer in CalHEERS. 2. Click Report a Change for 2014 link to process Report a Change (RAC) to remove deceased member from policy and tax household. 3. On the RAC Summary page. A. Click the Remove checkbox for deceased member. B. In the Select Life Event drop down, choose ‘None of the Above’. NOTE: 1. Assumes there is proof of death. 2. This will keep decease member in the household for 2014.IF: 1. The consumer has selected a plan and/or renewed it. 2. The consumer's plan status is "ENROLLED" or "PENDING." 3. The consumer HAS made their initial payment. THEN: 1. Search for consumer in CalHEERS. 2. Click Report a Change for 2015 link to process Report a Change (RAC) to remove deceased member from policy and tax household. 3. On the RAC Summary page, A. Click the Remove checkbox for deceased member. B. In the Select Life Event drop down, choose ‘None of the Above’. NOTES: 1. Assumes there is proof of death. 2. This will keep decease member in the household for 2014.IF: 1. The consumer has selected a plan and/or renewed it. 2. The consumer's plan status is "ENROLLED." 3. The consumer HAS made their initial payment. THEN: 1. Search for consumer in CalHEERS 2. Click Manual Verification button 3. On the Personal Verification page, A. For the Name, SSN, or date of birth i. Click the Clear Verification checkbox. ii. Update the Verification Status to “Not Verified”. B. Click the Save button. 4. IF update is for 2014, then click Report a Change for 2014 link to process Report a Change (RAC) 5. IF update is for 2015, then click Report a Change for 2015 link to process Report a Change (RAC) 6. On the Household Members page A. Update the SSN or date of birth B. Click the Continue button. 7. On the Application Signature page for Report Changes A. In the Do any of the following qualifying events or situations apply to you? drop down, select “Other qualifying event and enter “Update <Name, SSN, or date of birth>” in the text box. B. In the This Application qualifies for Special Enrollment as a result of a qualifying life event drop down, select “No”, C. In the Your Changes section D. Add the Reason from the drop down. E. Enter the current date for the Event Date. F. Click the I know that I must report any changes to information on this application…” check box. G. Click the Review and Sign check box. H. Click the Submit button.IF: 1. The consumer has selected a plan and/or renewed it. 2. The consumer's plan status is "ENROLLED." 3. The consumer HAS made their initial payment. THEN: 1. Do not use Quick Sort. 2. If the consumer wishes to remove Medi-Cal, the consumer must work with the counties. 3. Assist the consumer with reaching their county, see Sending Medi-Cal Calls Directly to Counties task guide.IF: 1. The consumer has selected a plan and/or renewed it. 2. The consumer's plan status is "ENROLLED." 3. The consumer HAS made their initial payment. THEN: 1. On the Individual Home page, under Actions, click the Update Consent for Verification link 2. On the Update Consent for Verification page A. Update the number of years in the Update my Consent for drop down B. Enter the date the consent was received in the Date Consent Received date field. C. Click the Update button 3. Search for consumer in CalHEERS 4. Click Manual Verification button 5. Click the Redetermine Eligibility button.IF: 1. The consumer has selected a plan and/or renewed it. 2. The consumer's plan status is "ENROLLED." 3. The consumer HAS made their initial payment. THEN: See job aid: Report a Change NOTE: After the Report A Change, the member who gained MEC will be discontinued from the previous subsidized program, but be eligible for an unsubsidized Covered California plan. IF: 1. The consumer has selected a plan and/or renewed it. 2. The consumer's plan status is "ENROLLED." 3. The consumer HAS made their initial payment. THEN: 1. Escalate the CRM incident to a Supervisor. NOTES (for supervisors): 1. See job aid: Escalating an Incident Job Aid. 2. There is an open ITSM ticket for the functionality to be corrected, #593936 IF: 1. The consumer has selected a plan and/or renewed it. 2. The consumer's plan status is "ENROLLED." 3. The consumer HAS made their initial payment. THEN: 1. Escalate the CRM incident to a Supervisor. NOTES (for supervisor): 1. See job aid: Escalating an Incident Job Aid. 2. The only way to access the APTC slider is to choose a new plan. The following are potential ways a Supervisor can do this: A. Change Plan link, which is available during open enrollment and may generate a new plan effective date. B. Report a Change i. See task guide: Report a Change Income. ii. Choose a change that will initiate the option to choose another health plan, such as moving, updating income, or adding a member. iii. The APTC slider will be available when choosing the plan. C. Slider on consumer homepage is scheduled for future release.