Autism Insurance and Mass Health Connector Time Sensitive Information Mass Health is not subject to the autism insurance law known as ARICA. There is currently an Open Enrollment period, through March 31, 2014, to purchase private insurance policies through the Health Connector “the Connector”. Policies purchased through the Connector (also known as Qualified Health Plans or QHPs), are subject to ARICA, and provide access to medically-‐necessary autism treatments, including Applied Behavior Analysis (ABA) therapy.
Key Facts: For families with Employer Sponsored Insurance (ESI): • Under the Affordable Care Act (ACA), individuals with Employer Sponsored Insurance can choose to enroll in a Health Connector Plan. This is a change from the Commonwealth Choice Plans offered through the Connector prior to the ACA. • This is particularly helpful for families who have Employer Sponsored Insurance that is not subject to ARICA, such as a self-‐funded plan. Under the ACA they can now purchase coverage from the Connector, either for an individual child or for the entire family, which will include coverage for autism treatments. • Federal tax credits and/or other financial subsidies may be able to help cover some, or all, of the costs of these policies. MassHealth Premium Assistance may also help cover the costs of unsubsidized Connector plans for children (see below). (Note – this document provides information only about Premium Assistance. For additional information on other assistance, please refer to The Mass Health Member Booklet for Health Coverage and Help Paying Costs. ) For families with MassHealth: • MassHealth may provide Premium Assistance for individual (not family), un-‐subsidized Health Connector Plans for children under 21 only who are in Standard or CommonHealth and are seeking coverage for services not covered by MassHealth, such as ABA services. Note that MassHealth will not pay premium assistance for a Health Connector Plan if the child has access to the needed services through Employer Sponsored Insurance, even if outside the open enrollment period for the Employer Sponsored Insurance. For families with MassHealth who are currently receiving Premium Assistance for Commonwealth Choice Plans: • Commonwealth Choice plans are being discontinued, with coverage for existing members scheduled to end by 3/31/14. In place of Commonwealth Choice plans, individuals have the option to enroll in a Health Connector Plan through the Health Connector. • MassHealth may provide Premium Assistance for individual (not family), un-‐subsidized Health Connector Plans for children under 21 only who are in Standard or CommonHealth and are seeking coverage for services not covered by MassHealth, such as ABA services.
To Obtain Coverage:
People interested in obtaining coverage should apply through the Connector. You can do so by visiting the Health Connector website at MAhealthconnector.org or by calling 877-‐MA-‐ENROLL. The online application process is detailed, and can be complicated. In addition, many individuals who have tried to apply online have encountered issues with the website that have made it difficult to complete their applications. The Connector has people available throughout the State to help individuals apply. They are known as Navigators and Certified Application Counselors (CAC). There is no charge for their assistance. We strongly recommend people who want to obtain coverage seek help from them. To get information about applying, to locate a Navigator or CAC, and/or to download a paper application, please visit the Health Center Page at the Connector Website, or call the Customer Service number listed above. For details about applying for Premium Assistance, please see the attached instructions, which were developed by MassHealth. Note – if you are visiting with a Navigator or CAC, we recommend bringing a copy of these instructions with you, as they may not all be familiar with the specifics of this process. For more information, assistance, or general information about the Autism Insurance Law, contact the Autism Insurance Resource Center. Go to www.disabilityinfo.org/arica or contact us at
[email protected]. We can be reached by phone at 774-‐455-‐4056 or 1-‐800-‐642-‐0249.
Steps to apply for Premium Assistance for a Health Connector Plan: Note that all of these steps apply to all individuals interested in applying for MassHealth premium assistance for a Health Connector Plan including those currently enrolled in MassHealth, not currently enrolled in MassHealth, currently enrolled in a Commonwealth Choice plan, or not currently enrolled in Commonwealth Choice. Note that, even if the individual is already a MassHealth member, these steps must be followed as eligibility needs to be established in the new MAhealthconnector.org system in order to also purchase a Health Connector plan. The current MassHealth eligibility will not be impacted by this process. 1. Apply for help paying for health insurance with the Health Connector. You can do so by calling 877-‐MA-‐ENROLL or by visiting the Health Connector website at MAhealthconnector.org. a. Click on the Individuals and Families tab, and then click on Get Started. b. On the screen, “Tell us about you,” answer how many members in your family, and answer Yes to the question, “Is anyone in your family disabled, blind, 65 years or older or in need of long-‐term-‐care?” By answering Yes, this will start your application for help paying for all or part of your health insurance. You do not want to avoid asking for help because you will not then qualify for Premium Assistance. c. Click on Start Your Application 2. You will need to create an account if you have not already done so and Login. 3. Once you start your application, the entire family must be included on the application for health insurance. If certain members of your household are not applying, include them and indicate that they are not applying. Answer all questions required for all household members. 4. Once your eligibility application is complete, a screen will display with your eligibility results. 5. On the left of the screen it should say “My Plans” and the top of the screen would say “Family Manager – Choose Plans for the Household.” Now is the time you would select plans for all eligible members. The top of the screen will display all MassHealth eligible members, and the
bottom of the screen will display all Health Connector Plan eligible members. You may see some family members appear in both sections. At this time you have two options: 1. Call the MassHealth Premium Assistance Unit to inquire about how much premium assistance is available for your child. This will help you make an informed decision in regards to enrollment in an individual Health Connector Plan for your child needing Applied Behavior Analysis (ABA) services. OR 2. Enroll in an individual Health Connector Plan for the child needing ABA services immediately and call the Premium Assistance Unit later. 6. To enroll in a Health Connector Plan immediately without exiting the MA Health Connector website, you would do so on the “My Plans” screen. If you want to take some time to call the Premium Assistance Unit or think about which plan you would like to enroll your child in, you may exit the website and come back at a later time. If you choose to come back later, you would again visit MAhealthconnector.org and select “My Plans” a. At the bottom of the screen in the “Health Connector Plan eligible member section” you want check the box next to the name of your child who is need of ABA services and then click on the button that reads “Shop Health Plans for Selected members.” (Please keep in mind if you have more than one child that is in need of ABA services, you need to select each child’s plan separately in order to receive Premium Assistance.) b. At this point you may choose a plan based on your child’s needs and the information provided in this document.
Next Steps after enrolling in an Individual Health Connector Plan Once you have enrolled your child in a Health Connector Plan, you must submit proof of enrollment, which must include the premium amount to MassHealth. It is a good idea to follow-‐up with a phone call to Premium Assistance 5 business days after submitting the forms to confirm that all materials were received and that they have everything they need.
Your MassHealth Premium Assistance contacts are: Lekecia Powell-‐Watkins at 617-‐886-‐8263 Samantha Laskey at 617-‐886-‐8058 Please fax or email your Health Connector Plan enrollment confirmation to Lekecia.Powell-‐
[email protected] or
[email protected] Fax # 617-‐886-‐8400 (Attn: Lekecia or Samantha) If you have any questions about the process to enroll your child(ren) in a Health Connector Plan, please call 1-‐877-‐MA-‐ENROLL (877-‐623-‐6765). For more information, assistance or general information about the Autism Insurance Law, contact the Autism Insurance Resource Center. Go to www.disabilityinfo.org/arica or contact us at
[email protected]. We can be reached by phone at 774-‐455-‐4056 or 1-‐800-‐642-‐0249.