COMMUNITY PARTNER WEBINAR JULY 2, 2014
AGENDA Community Outreach Network (CON) Update FAQs o Prescription Coverage o Pregnancy Coverage Open Enrollment Announcement Updates to CoveredCA.com o Special Enrollment Application Changes Navigator Program Updates CEE Payment Update Resources 2
COMMUNITY OUTREACH NETWORK (CON) PARTNERS THEIR ROLE AND HOW OTHER PARTNERS CAN WORK WITH THEM
COMMUNITY OUTREACH NETWORK (CON) PARTNERS WHAT IS THE COMMUNITY OUTREACH NETWORK (CON)? Organizations and stakeholders who are volunteer partners with Covered California. They raise public awareness and understanding of the new health insurance marketplace where people live, shop, work and play. They are not compensated. MISSION To promote a culture of coverage, and raise awareness and understanding of the health care coverage through Covered California health insurance companies. 4
COMMUNITY OUTREACH NETWORK (CON) PARTNERS OBJECTIVE Ensure the broadest outreach to individual consumers and small-business employers Inform and motivate target populations to enroll TARGET POPULATIONS Young invincibles Culturally diverse populations and communities Populations with Limited English Proficiency Priority employment sectors 5
COMMUNITY OUTREACH NETWORK (CON) PARTNERS TYPES OF CON PARTNERS Community clinics, local hospitals and health providers Labor union members Trade, industry and professional organizations, e.g. food and hospitality Employment sectors, e.g. retail and construction Local city government agencies Faith-based organizations Chambers of commerce School districts and after-school programs Community colleges and universities 6
COMMUNITY OUTREACH NETWORK (CON) PARTNERS RESOURCES AVAILABLE TO CON PARTNERS Participate in joint stakeholder webinars with our other Covered California partners: Certified Educators, Certified Enrollment Entities/Counselors, and Plan Based Enrollers An online toolkit that includes Covered California 101 presentation deck, co-branding style guide and logos, printable materials, etc. Access to the Covered California Collateral Print House to order collateral materials with a quarterly budget Email updates of the latest news and tips Bi-monthly newsletter with helpful information E-mail address inbox directly to a dedicated staff Covered California staff to help support the Partners outreach efforts Dedicated webpage on CoveredCA.com 7
COMMUNITY OUTREACH NETWORK (CON) PARTNERS ROLE OF PARTNERS Partners may be involved at various levels based on their capacity and resources to: Present information in the community Attend grassroots events and help distribute informational materials Displaying collateral information materials in their office or in public spaces Host designated enrollment drives and other special events as needed Refer organizations/stakeholders to join the Community Outreach Network Partner with other organizations for outreach and education 8
COMMUNITY OUTREACH NETWORK (CON) PARTNERS WHAT S IN IT FOR OUR PARTNERS! Improving the health of the communities served Serving as a trusted voice or point of contact for Covered California in the community Collaborating with Certified Educators, Certified Enrollment Counselors, and Certified Insurance Agents in identifying gaps and opportunities for outreach and education in target population areas Playing a major role in the expansion of health care in California 9
COMMUNITY OUTREACH NETWORK (CON) PARTNERS HOW OUR COMMUNITY OUTREACH NETWORK PARTNERS CAN HELP YOU Offering facility space for outreach, education, and/or enrollment events Volunteer to educate consumers at events Co-hosting enrollment events Volunteer in areas needed at events except for enrollment Pass out event flyers Post announcements or events on their website or social media Speak/Present at events Note: CON Partners are not certified to enroll consumers into Covered California health plans 10
COMMUNITY OUTREACH NETWORK (CON) PARTNERS JOIN THE COMMUNITY OUTREACH NETWORK! 1. Submit an interest form http://hbex.coveredca.com/community-outreach-network/forms/interest-form.pdf 2. Sign Memorandum of Understanding (MOU) 3. Attend webinars hosted by the Community Relations Staff or review the online recording 4. Register for an account on the Covered California Collateral Print House and order collateral materials 5. Demonstrate familiarity with and ability to convey Covered California messages accurately and consistently 6. Spread the word! 11
FAQS: PRESCRIPTION & PREGNANCY COVERAGE
PRESCRIPTION COVERAGE FAQS WHAT PRESCRIPTION DRUGS WILL A HEALTH PLAN COVER? The set of prescription drugs covered by a health plan is also called a formulary, prescription drug list, outpatient drug list or select drug list. To find this information for Covered California health plans, consumers can: Check the formulary information on the health plan s website. A list of all Covered California health plans formulary information can be found at: http://www.coveredca.com/faqs/prescription-drugs/ Call their health plan s customer service number directly to find out more information on prescription drug coverage. 13
PRESCRIPTION COVERAGE FAQS WHAT IF A HEALTH PLAN DOES NOT COVER A NEEDED PRESCRIPTION? The consumer should contact the health plan s customer service line and ask for potential substitute medications and associated out-of-pocket costs. The consumer should ask their physician if the health plan s alternatives are a reasonable substitute. If not, a physician can to file an appeal to get an exception. Health plan formularies will include drug coverage for most types of conditions. If consumers need help talking to a health plan company, they should contact the Health Consumer Alliance (HCA), which offers free assistance to Covered California health plan members. Health Consumer Alliance: 1 (888) 804-3536 or www.healthconsumer.org 14
PRESCRIPTION COVERAGE FAQS HOW MUCH DO PRESCRIPTION DRUGS COST THROUGH COVERED CALIFORNIA? Generic drugs are the cheapest, preferred drugs are more expensive and non-preferred brand and specialty drugs are the most expensive options. Out-of-pocket costs vary depending on the metal tier of a health plan. Consumers can research the costs of prescription drugs in the Preview Plans section of CoveredCA.com. For example, prescription drug costs for Silver tier health plans are: Generic: $19 co-pay in 2014, are not subject to a deductible. Preferred: $50 co-pay, after meeting $250 deductible ($500 for a family). Non-Preferred: $70 co-pay, after meeting $250 deductible ($500 for a family). Specialty drugs: 20% co-insurance, after meeting $250 deductible ($500 for a family). 15
PREGNANCY COVERAGE FAQS WHAT COVERAGE OPTIONS ARE AVAILABLE FOR PREGNANT WOMEN? There are several options available for pregnant women in California: Covered California Health Plans Medi-Cal - Presumptive Eligibility Medi-Cal - Pregnancy-Related (Restricted-Scope) Medi-Cal - Full-Scope Medi-Cal Access for Infants and Mothers (AIM) WHEN CAN PREGNANT WOMEN ENROLL IN A HEALTH PLAN? Pregnancy is not considered a special enrollment qualifying life event for Covered California ( birth or adoption of child is a Covered California qualifying event). However, Medi-Cal and AIM enroll new members throughout the year. 16
PREGNANCY COVERAGE FAQS WHAT IS PRESUMPTIVE ELIGIBILITY MEDI-CAL (PE)? No-cost Medi-Cal program designed to provide immediate, temporary coverage of prenatal care to low-income pregnant women pending submission of a formal Medi-Cal application. Any woman who thinks she is pregnant, has a household income at or below 213% of FPL and does not have an existing Medi-Cal case may qualify for PE coverage. PE is temporary coverage of up to 2 months (for the month the woman applies for PE through the end of the following month). PE coverage offers specific outpatient prenatal care, outpatient abortion procedures, prescription drugs for conditions related to pregnancy, and limited preventive dental services. It does NOT cover labor and delivery, family planning or inpatient care. Therefore, PE patients must submit a formal Medi-Cal application to continue receiving coverage. 17
PREGNANCY COVERAGE FAQS WHAT IS PREGNANCY-RELATED MEDI-CAL? Pregnant women with household income up to 213% of the FPL are eligible for pregnancy-related (or restricted-scope) Medi-Cal. The mother s immigration status is not a factor in eligibility. Coverage includes prenatal care, labor and delivery, dental care and certain other medical services. There is no cost for pregnancy-related coverage. The infant is automatically covered for the first year of life, with no family income limit. Postpartum coverage is also included and continues for up to 60 days post delivery. 18
PREGNANCY COVERAGE FAQS WHAT IS FULL-SCOPE MEDI-CAL? Pregnant women with other children in the home a income up to 109% of the FPL are eligible for full-scope Medi-Cal benefits. New legislation (SB 857) increased the full-scope eligibility for pregnant women to 138% FPL, but the effective date of this increase is not yet known. There is no cost for the mother in full-scope Medi-Cal. Coverage includes general medical care, prenatal care, labor and delivery and also dental care. The newborn is automatically eligible for Medi-Cal at birth with no family income limit for the first year of life. 19
PREGNANCY COVERAGE FAQS WHAT IS ACCESS FOR INFANTS AND MOTHERS (AIM)? New legislation (SB 857) transferred this program from MRMIB to DHCS and renamed it Medi- Cal Access Program. At this time, the program remains exactly the same. Stay tuned for updates. Eligibility includes pregnant women with household income over 213% of the FPL and up to 322% of the FPL. The mother s immigration status is not a factor in eligibility. AIM provides low cost comprehensive coverage, with no copays, deductibles or coinsurance. The infant is automatically covered for the first year of life, with no family income limit; in the second year of life the infant remains eligible for Medi-Cal with income up to 322% of the FPL. Postpartum coverage is also included and continues for up to 60 days post delivery. 20
2014 2015 OPEN ENROLLMENT PERIOD 21
COVEREDCA.COM UPDATE
COVEREDCA.COM UPDATE The Special Enrollment prompt has been moved to the Application Signature page within the Eligibility section Previously located in the Apply for Benefits page within the Start section 23
COVEREDCA.COM UPDATE Qualifying Life Events: Lost or will soon lose my health insurance (was: Lost my health insurance including Medi- Cal) Permanently moved to/within California Had a baby or adopted a child (was: Had a baby. Adopted a child) Got married or entered into a domestic partnership Returned from active duty military service 24
COVEREDCA.COM UPDATE Qualifying Life Events: Released from jail or prison (was: Released from incarceration) Gained citizenship/lawful presence Federally Recognized American Indian/Alaska Native (was: American Indian/Alaskan Native) Other qualifying life event None of the above (Continue to review my application for Medi-Cal/AIM) (was: None of the above) 25
LIMITED-TERM SPECIAL ENROLLMENT COBRA If a plan is selected by the 15th, coverage starts on the 1st of the following month. If a plan is selected after the 15th, coverage starts on the 1st of the second following month May 15 July 15, 2014 Anyone currently on COBRA The date the consumer is applying is not necessarily the COBRA termination or end date. Select Other in the drop-down menu 26
COVEREDCA.COM UPDATE After clicking Submit, those consumers who selected the Other life event will see this message: Your eligibility results are not final yet, we still need to review your qualifying life event. You will receive notice from us with more information. You may also call the Service Center at 1-800-300-1506 for more information. 27
COVERAGE EFFECTIVE DATES QUALIFYING EVENTS Enrollment Date Premium Due Date Coverage Effective Date Between the 1 st and 15 th of the month Four business days before the end of each month: June 25 The first day of the following month For a consumer who enrolled on June 10, coverage will be effective July 1 Between the 16th and last day of the month Four business days before the end of each month: July 28 The first day of the second following month For a consumer who enrolled on June 17, coverage will be effective August 1 Different coverage effective dates may apply for the following life events: had a baby/adopted, married/domestic partnership, and other life event circumstances. For details regarding these circumstances, consumers should contact the Service Center at 800-300-1506 28
NAVIGATOR PROGRAM UPDATES
NAVIGATOR PROGRAM UPDATE Covered California released a Request for Application for the Navigator Grant Program on June 30, 2014. Up to $16.9 million for an integrated grant program that will provide outreach, education, enrollment and post-enrollment support to Covered California subsidy eligible consumers. Webinar on July 1, 2014. To listen to a recording or for more information, visit the Navigator website at: http://hbex.coveredca.com/navigator-program/. 30
CEE PAYMENT UPDATE
CEE PAYMENT UPDATE Certified Enrollment Entity (CEE) Payments through June 30, 2014 # CEEs Paid Total Paid Covered CA Plans 527 $1,956,398 Medi-Cal 388 $1,129,144 Total Payments $3,085,542 NEXT SCHEDULED PAYMENTS Covered CA Medi-Cal August 1, 2014 32
RESOURCES
HEALTH CONSUMER ALLIANCE The Health Consumer Alliance (HCA) is a partnership between Legal Aid organizations. They provide free local assistance to individuals and families applying for or enrolled in Covered California or Medi-Cal. CECs may refer consumers to HCA for additional help and information. Go to www.healthconsumer.org for contact information by county OR call 888-804-3536. 34
COVEREDCA.COM RESOURCES For more information on Special Enrollment go to: http://www.coveredca.com/faqs/special-enrollment/ https://www.coveredca.com/coverage-basics/special-enrollment/ https://www.coveredca.com/faqs/cobra/ For more information on Medi-Cal and pregnancy: https://www.coveredca.com/faqs/medi-cal/ http://www.dhcs.ca.gov/ For more information on prescription drugs: http://www.coveredca.com/faqs/prescription-drugs/ For more information on the Navigator Program: http://hbex.coveredca.com/navigator-program/ 35
COVEREDCA.COM RESOURCES THE PRESENTATION PORTION OF THIS WEBINAR HAS CONCLUDED YOU MAY CONTINUE TO SUBMIT QUESTIONS VIA THE QUESTION BOX 36