Affordable Care Act Enrollment Template.docx



HEALTH INSURANCE ENROLLMENT ASSISTANCE TEMPLATEOPTION 1: Programs that focus on Marketplace enrollment and refer clients elsewhere for Medicaid/HIP enrollment. (Note: These programs do screen for Medicaid/HIP eligibility, and may forward the paperwork to the correct agency, but don’t do the actual enrollment for those programs.)Service Group: HEALTH INSURANCEProgram AKAs:Health Insurance ExchangeHealthcare NavigatorsHealth Insurance MarketplaceHealth Care NavigatorsTaxonomyMatchlist NoteAffordable Care Act Information/counselingIn-person enrollment; {dates, if limited} Description/Published Description:Provides in-person information and enrollment assistance for plans in the Health Insurance Marketplace established by the Affordable Care Act.Modify above as appropriate, for example:Instead, start with: “Provides referrals to opportunities for …”Add at the end: “Services are available at various locations throughout…. “Add at the end: “Services are available during the open enrollment period.”Eligibility:For Information and Assistance: OpenFor Marketplace Enrollment: * Household income at least 100% Federal Poverty Level (for subsidy, household income must be between 100%-400% FPL) * US citizen or legal resident * Not currently incarcerated * Outside of annual open enrollment period (November 15 to February 15): With a qualifying life event (such as marriage, divorce, birth/adoption, change in employment, move to a new provider region)Intake:Call to schedule an appointment.Call the appointment line and leave contact information for a return call to schedule an appointment.Walk in; enrollment assistance is provided on a first-come, first-served basis.Examples only; modify above as needed.What to Bring:* Government-issued photo ID* Social Security numbers for all household members* Proof of household income amount* Information about any current or available employer-sponsored health insurance (if applicable)Confirm/modify above for specific agency.Fees:None for information/enrollment assistance; Marketplace insurance premiums vary by plan; subsidies (financial assistance) available by incomeOPTION 2: Programs that provide enrollment assistance equally for Medicaid/Hoosier Healthwise, Healthy Indiana Plan (HIP), and Affordable Care Act Marketplace.Service Group: HEALTH INSURANCEProgram AKAs:Health Insurance ExchangeHealthcare NavigatorsHealth Insurance MarketplaceHealth Care NavigatorsHealthy Indiana PlanHIPTaxonomyMatchlist NoteAffordable Care Act Information/counselingIn-person enrollment for the Marketplace, Medicaid, and HIPMedicaid Information/CounselingIn-person enrollment for the Marketplace, Medicaid, and HIPState/Local Health Insurance Information/CounselingIn-person enrollment for the Marketplace, Medicaid, and HIPDescription/Published Description:Provides information, guidance, and enrollment assistance with health insurance plans including Medicaid/Hoosier Healthwise, the Healthy Indiana Plan (HIP), and the Health Insurance Marketplace established by the Affordable Care Act.Modify above as appropriate, for example:Instead, start with: “Provides referrals to opportunities for …”Add at the end: “Services are available at various locations throughout…. “Eligibility:* For Information and Enrollment Assistance: Open* Eligibility for specific plans varies based on income, age, and other factors. To apply for the Healthcare Marketplace outside of the open enrollment period (November 15 to February 15), individuals must have a qualifying life event, such as marriage, divorce, birth/adoption, change in employment, or move to a new provider region.Intake:Call to schedule an appointment.Call the appointment line and leave contact information for a return call to schedule an appointment.Walk in; enrollment assistance is provided on a first-come, first-served basis.Examples only; modify above as needed.What to Bring* Government-issued photo ID* Social Security numbers for all household members* Proof of household income amount* Information about any current or available employer-sponsored health insurance (if applicable)Confirm/modify above for specific agency.FeesNone for information/enrollment assistanceSpecific health insurance plans may have premiums based on income. ................
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