JOB AID: RENEWAL

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October 7, 2015

2016 Covered California Renewal

Covered California’s renewal period (annual redetermination process), October 12 through

December 15, 2015, is intended to help Individuals and Families retain health coverage for

2016. This Job Aid is for Service Center Representatives, County Eligibility Workers, Plan-

Based Enrollers, Certified Enrollment Counselors, and Certified Insurance Agents who are

assisting consumers to complete their renewal, and illustrates the functionality from the

consumer’s perspective.

Who Is Qualified for Renewal?

As part of annual renewal, eligibility will be re-determined for subsidized and unsubsidized

households that are enrolled in a plan and have made their first premium payment (i.e.,

effectuated) or pending (enrolled in a plan with pending effectuation). Households are selected

for renewal if they provided consent for verification for the upcoming coverage year. Notices will

be sent to qualifying households to notify them of their opportunity to update information and

confirm plan choices for the upcoming year. Note: APTC households who do not provide

consent for verification are auto-renewed into an unsubsidized plan (income verification is not

required).

Households Not Eligible For Renewal

Applications which were withdrawn or terminated

Cases which opted out of renewal during the renewal timeframe (between the dates of

October 12 and December 15, 2015)

For Households who are not eligible for Renewal, the Apply Now button displays on the

Individual Landing page instead of the Continue button:

JOB AID: RENEWAL

Your destination for affordable,

quality health care, including Medi-Cal

JOB AID: RENEWAL

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Renew Mode

A household in Renew mode displays an Individual Landing page with the message: It’s time to

renew your coverage. One of three program-specific Renewal sections displays, along with

instructions on how to continue coverage for the next benefit year.

Depending on the program-specific Renewal section displaying, clicking the Continue button

navigates the Consumer to a page to confirm their household information:

California Renewal - navigates the user to the Renewal Summary page

Mixed Household Renewal - navigates the user to the Renewal Summary page

Medi-Cal Renewal – navigates the user to the Report a Change Summary page

JOB AID: RENEWAL

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Some important points about Renewals:

The Preview and Apply tabs in the global header are inactive until the renewal is

complete.

If the renewal has already been initiated but eligibility has not been finalized, the

Renewal Summary page (or Report a Change Summary page for Medi-Cal Renewal)

displays to allow the Consumer to resume progress. The Consumer can continue to

review and submit their information to complete the renewal.

If eligibility has been finalized but plan selection has not been confirmed, the Household

Enrollment Introduction page displays. The Consumer can continue to confirm plans for

2016.

If the renewal was initiated by SAWS and plan selection is complete, the following text

displays instead: “Your case is under review, please contact your county worker for

further information.”

Renew Mode Page - Opt In/Out

An Admin user (Service Center Representative or County Eligibility Worker) has the functional

option to move a case out of Renew mode (exempt it), and then back into Renew mode, if a

process or policy should warrant this action.

Note: If a household has completed the renewal process for the upcoming year, access to the

Renew Mode page is not available.

1. From the Search Individual page, enter search

criteria to locate the consumer, and then click the

corresponding radio button from the results list.

Click the Manual Verification button. The

Household Verifications page displays.

2. Click the Renew Mode tab from the left-hand

Verification panel. The Renew Mode page

displays.

Exempt Case from Renewal

3. Select the Off value from the dropdown

and then click the Update button.

4. An Opt-in / Opt-out Confirmation

popup displays stating: Your update

has been successfully saved.

5. Click the Ok button. The Individual

Landing page reflects the consumer is

no longer in Renew mode.

JOB AID: RENEWAL

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Repeat the above steps to move the

consumer back into Renew mode—only

this time, select the On value.

The following content gives an overview of

a Covered California Renewal.

Renewal Summary Page

The Renewal Summary page displays 2015 household information. Each section should be

reviewed to confirm it is correct for the upcoming coverage year. Once the information is

submitted, it is used to determine

eligibility for 2016.

1. Review all the information

displayed on the Renewal

Summary page.

If there is new information for

2016, click the Edit button in the

section that needs updating and

enter the new information.

To add a household member, for

example, click the Add

Household Member button at

the bottom of the Renewal

Summary page and complete

the pages required.

If there is no new information

for 2016, click the Continue

button at the bottom of the

Renewal Summary page to

proceed to the Signature for

Renewal page to sign and

submit the consumer’s

renewal application.

Note that information entered

during the renewal applies to

the upcoming coverage year

and may impact eligibility for

insurance affordability

programs as of January 1,

2016.

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Examples of the types of changes that may impact eligibility include:

Change of physical Address

Change in Household Income

Add or Remove a Household Member

2. When all household information for the upcoming coverage year is confirmed, click the Continue button at the bottom of the Renewal Summary page.

Voter Registration

The Voter Registration page displays

allowing the consumer an opportunity to

register to vote. After selecting an option,

click the Continue button. The Signature

for Renewal page displays.

Signature for Renewal

3. The Signature for Renewal page

displays. On the Signature for

Renewal page, review any changes in

the Your Changes section.

Each type of change has a

corresponding dropdown list for the

change Reason with

options unique to the

Type of Change. Select

the appropriate option,

and then enter the Event

Date. If there are no

changes, the section is

blank as shown. The

Cancel all changes link

displays only if changes

are detected.

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4. Attest to the statement, “I know that I must report any changes to information on this

application”, under the Your Changes section by clicking the checkbox.

5. Click the Declaration

checkbox in the Review and

Sign section. Note that the

Submit button at the bottom

of the page is disabled until

all checkboxes on the

Signature for Renewal

page are checked.

6. The Consumer enters their

Electronic Signature and

Electronic PIN number to

sign the renewal. Click the

Submit button at the bottom

of the page to submit the

renewal application and

initiate the eligibility

determination.

Note: The Review and Sign

section does not display for

the Service Center

Representative or County

Eligibility Worker.

JOB AID: RENEWAL

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Renewal Results

The Renewal Results page

displays a summary of health

care programs the household

is eligible for in the upcoming

coverage year.

Carefully review the eligibility

information on this page with

the Consumer. The household

may be eligible for different

programs or required to

provide documentation to

ensure the household obtains

or retains coverage for 2016

that is appropriate for their

eligibility.

To view a PDF version of the submitted renewal application, click the Submitted Application

button at the bottom of the Renewal Results page.

To save your

information and exit

the renewal, click

the Save & Exit

button. You will be

navigated to the

Individual Landing

page.

7. Click the

Choose Health

Plan button on

the Renewal

Results page to

navigate to the

Health

Enrollment

Introduction

page to confirm

or change plan

choice for 2016.

JOB AID: RENEWAL

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Note: The Choose Health Plan button does not display on the Renewal Results page for

all eligibility situations. For example, for Medi-Cal eligible cases, the following text displays

instead: “If you or members of your family end up being eligible for Medi-Cal coverage, your

county human services agency will contact you.”

Renew Health Plans

The Household Enrollment Introduction page displays the health programs for which the

household members are eligible. For Covered California plans, eligible Consumers have the

option to keep their current plan or shop for a new one.

Covered California Plan Auto-Enrollment

Covered California will automatically enroll eligible household members in their current plan or

similar plan if the Consumer does not select a new plan by the date displayed on the Household

Enrollment Introduction page.

Health insurance carriers will notify consumers of a 2016 plan substitution to a similar plan if

their 2015 plan is no longer available. If the current plan is not available for 2016, the Consumer

must take action and select a new plan no later than December 15, 2015 to prevent a break in

coverage. (Note: The health insurance carrier will provide notice to the Individual if a plan will

not be available in the upcoming coverage year.)

In most cases, if the consumer does not select a plan by the date shown on the Household

Enrollment Introduction page, Covered California auto-enrolls them in the same plan for the

upcoming benefit year.

JOB AID: RENEWAL

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Choose a Health Plan for 2016

8. Click the Choose Health Plan button on the Household Enrollment Introduction page to

review and confirm plan or make a new plan choice. The Getting Started page appears.

The Getting Started page allows the Consumer to review their current plan information, and

keep their current plan or select a new plan for coverage effective January 1, 2016.

Consumers should review the details

of their plan carefully as the premium

rates, plan network or coverage

details might have changed for 2016.

It is also possible that the amount of

the 2016 Premium Tax Credit is

different from the amount received

for 2015. To keep the existing plan,

click the Keep button.

To shop for a new plan for 2016, click

the Shop button on the Getting

Started page.

JOB AID: RENEWAL

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Select a New Plan for 2016

The Getting Started page welcomes the Consumer to the Plan Selection process. Click Next to

navigate to the Browse Plans page.

The Browse plans page

allows the Consumer to

browse and compare their

2015 plan to those

available for 2016. From

this page, the Consumer

can shop for a new plan or

add their existing plan to

their cart. The first plan

displayed on the Browse

plans page is the same or

the most like their 2015

plan. Click the Add button

to add the plan to Your

Cart to confirm the plan

choice for 2016.

When plan selection for

2016 has been confirmed,

the Provide eSignature

page displays. Review the information on the Provide eSignature page with the Consumer.

The consumer attests to the statement, “I agree to file a (2016) tax return before (April 15,

2017) to claim the Premium Tax Credit,” by clicking on the adjacent checkbox.

JOB AID: RENEWAL

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Select the I Have Read and

Agree to the Binding

Arbitration Agreement

checkbox. The Consumer

then enters their PIN in the

Pin Number field and types

their full name in the

eSignature field.

Click the Enroll button at the

bottom of the page to continue.

The Confirmation page displays the new plan for coverage effective January 1, 2016. Click the

Continue button at the bottom of the page to review the household’s plan enrollment.

JOB AID: RENEWAL

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Dental Coverage

Continue the enrollment process by

selecting or opting out of dental

coverage. Family dental plan

selection is offered to a household

with at least one adult member

enrolled in a Covered California

Plan. Note: Children’s dental

coverage is embedded in their

health plan.

Household Enrollment

Summary

The Household

Enrollment Summary

page provides information

about the household’s

enrollments, including the

initial payment due date.

Click the How to Pay link

to view details on how to

make payments directly to

the health insurance plan.

View plan enrollment information by coverage year on the Household Enrollment Summary

page. Select from the Viewing Enrollment Information for dropdown to view plans by

coverage year.

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Click the Take Survey button to navigate to a Covered California survey to provide feedback on

the Consumer experience. Click the View Additional Programs button to navigate to the

Additional Programs page. Click the Done button to return to the Individual Landing page.

Note: Consumers may change their medical plan and/or dental plan choice made in Renewal

during the Open Enrollment period for the upcoming coverage year by clicking the Change Plan

link in the Actions section on the Individual Landing page.

Auto Enrollment

Auto-enrollment is a batch process that automatically re-enrolls an eligible household in the

same plan for the upcoming coverage year if they have not confirmed their current plan or

selected a new plan by the due date indicated on the Health Enrollment Summary page. The

last batch run for auto-enrollment will occur 12/13/15 through to 12/15/15 to enroll with an

effective date of 1/1/2016.

Note the following cases are not eligible for auto-renewal:

MAGI Medi-Cal only cases

Cases terminated before October 12, 2015

Cases enrolled with a Special Enrollment event after October 12, 2015