Siga las instrucciones aquí para traducir esta página a otro idioma usando Chrome.
Plan shopping and the subsidy application are distinct parts of the flow that culminate in an enrollment submission. After enrollment submission, there are several milestones that often determine whether coverage takes effect.
In this article we’ll cover:
Enrollment submission flow
An enrollment submission takes place once the subsidy application is submitted and plan selection is finalized. With consent, agents can assist consumers with enrollment submission.
Enrollment submission can begin with completing the subsidy application or with plan shopping. These paths are known as apply first and shop first.
Apply first
Apply first
Apply first refers to starting the enrollment submission process by updating or beginning a consumer’s subsidy application. Once the subsidy application is submitted to the Marketplace, a Marketplace Eligibility Notice is generated with the consumer’s final eligibility results.
If the consumer is within an enrollment period, proceed to reviewing available plans to find a plan that fits the consumer’s needs.
Confirm the consumer’s final selections to submit the enrollment.
Shop first
Shop first
Shop first refers to starting the enrollment submission process by reviewing available plans with the consumer using estimated subsidy eligibility. Use discovery questions to narrow options and identify a plan that fits the consumer’s needs.
After a plan is selected, update or begin the consumer’s subsidy application. Once the subsidy application is submitted to the Marketplace, a Marketplace Eligibility Notice is generated with the consumer’s final eligibility results.
If the consumer is within an enrollment period, review alternative plans if desired, then confirm the consumer’s final selections to submit the enrollment.
How an agent initiates the enrollment submission flow depends on the time of year and whether the consumer is already listed on the Clients page of the HealthSherpa account.
During the Open Enrollment Period (OEP), use the available renewal pathways to assist consumers who are already on the Clients page.
To assist consumers who are already on the Clients page and seeking a Special Enrollment Period (SEP), edit the application from the client's Details page.
Use Start application & Search Marketplace or Quote functionality to assist consumers who are not already on the Clients page.
Post-submission milestones
After an enrollment is submitted, additional milestones may be required to support policy effectuation.
Common post-submission milestones in the enrollment journey include:
Documentation
Documentation
The Marketplace may require documentation to resolve Data Matching Issues (DMIs) or Special Enrollment Period (SEP) Verification Issues (SVIs). If a DMI is not resolved, the consumer may lose advance premium tax credit (APTC) or Marketplace eligibility. If an SVI is not resolved, the consumer may lose SEP eligibility.
Binder payment
Binder payment
Consumers often need to make a binder payment, also called an initial payment or first month’s premium, for coverage to effectuate. Binder payments can often be made through HealthSherpa and are paid directly to the carrier.
When applicable, the policy takes effect only after these milestones are completed.
Once coverage is effective, post-enrollment servicing can begin. During servicing, the consumer receives an ID card and other membership materials from the carrier.
Frequently asked questions
What is a Marketplace Eligibility Notice?
A Marketplace Eligibility Notice is an official letter from the Marketplace that is generated after a consumer’s subsidy application is submitted.
This notice explains the household’s coverage eligibility and financial assistance, known as subsidies, along with any follow-up actions needed to resolve Data Matching Issues (DMIs) & Special Enrollment Period (SEP) Verification Issues (SVIs).
What is a subsidy?
A subsidy is federal financial assistance designed to lower the cost of health insurance purchased through the Marketplace. Subsidy eligibility can consist of both advance premium tax credit (APTC) and cost-sharing reduction (CSR).
APTC: Refers to a dollar amount that may be applied on a consumer’s behalf to their monthly health insurance premium. APTC can be applied to all metal levels and may appear as Estimated savings in HealthSherpa.
CSR: A discount applied to silver level plans that lowers deductibles and out-of-pocket costs for care and prescription drugs. Consumers who are eligible for APTC may also be eligible for CSR. Consumers who are not eligible for APTC are not eligible for CSR.
What are enrollment periods?
Enrollment periods are specified times of the year when consumers can enroll in or make changes to Affordable Care Act (ACA) coverage.
What does effectuate mean?
Enrollment effectuation means coverage begins.
Additional resources
For help using HealthSherpa or for other assistance, contact Agent Support. Agent Support is available by phone at (888) 684-1373, by email at Agent_Support@HealthSherpa.com, or by chat directly from your account.