With Multiple Enrollment Groups, it's easy for Agents to do the following:
place applicants in different plans on the same application
place applicants in the same plan, but in separate groups
When Multiple Enrollment Groups may be useful
Agents may want to select multiple plans for a single application in the following scenarios:
When applicants have different health needs
When applicants have different provider needs
When applicants have different prescription drug needs
Agents may also want to separately enroll applicants who've chosen the same plan in the following scenarios:
When one applicant is AI/AN, and the others aren't
When one applicant qualifies for CSR, and the others don't
When applicants want separate deductibles, etc.
Summary of how it works
After filling out the application, you'll be able to shop different plans for different applicants
Applicants on their own plan have their own separate premium payment, deductible, out-of-pocket max.
If any applicants are on the same plan, they'll be in a "group" – on the same premium payment, family deductible, and family out-of-pocket max. You will find directions on how to opt out of grouping applicants who choose the same plan later in this article.
The premium subsidy for the household will be portioned out between applicants using a formula from CMS. If an applicant doesn't use all of their subsidy portion, it goes to the next applicant in the list.
How to access Multiple Enrollment Groups
You'll have access to shop Multiple Enrollment Groups after you've done the application, not during Quoting.
The easiest way to access Multiple Enrollment Groups is through our EDE application flow – but it's also possible on the double-redirect application flow.
At the end of the EDE flow, you'll reach the Eligibility Results page. If you haven't already chosen a plan, you'll see the "Shop Multiple Plans" button at the bottom.
You'll also always have access to shop multiple plans from the final Confirm Plans page. (This is where you'll see the link for the first time if you've done a double-redirect application.)
If you haven't already selected multiple plans, you can do so here with the "Shop multiple plans" button. If you have already selected multiple plans, you can edit the plans with the "Change plans" button.
When you click the Shop Multiple Plans button, you'll land here on the Group Shopping page. First, select which applicants you'd like to shop for, then press "Choose a plan."
From there you'll be taken to the Plan List where you can shop plans for those selected applicants. As you shop, you'll see the subsidy portion for those particular applicants applied to the plans (using the per-applicant subsidy formula from CMS). Add the chosen plan to your cart and press "Select this plan" from the cart to be taken back to the Group Shopping page.
How to opt out of grouping applicants
By default, any applicants that have the same plan selected will be put into a "group" – meaning they'll be on the same premium payment, family deductible, and family out-of-pocket max (just like normal).
If you'd like to opt out of grouping applicants who've chosen the same plan, just uncheck this box:
Why opting out of groups can be useful: If one applicant is eligible for extra savings (e.g. a Cost-Sharing Reduction or is an American Indian or Alaska Native), they wouldn't be able to keep their benefit if the rest of the enrollment group is ineligible.
Once you've shopped for everyone, click "Continue" to proceed to the Confirm Plans page, where you'll see all the plans and groupings you've selected.
Here's how multiple plans appear in your Dashboard after the enrollment is done.
After you submit the enrollment, on the Success page, you'll see multiple payment buttons – one per group.
On the Client Profiles, you'll also see multiple payment buttons – one per group.
On the Client Profiles, all "Change plans" buttons will point to the Group Shopping page.
On the Client List, you'll see the plan selected by the primary applicant. Click into the Client Profile to see all the plans.
The premium subsidy for the household will be portioned out between applicants using a formula from CMS – mostly determined by age of applicant.
When you shop for multiple plans, you'll see the premium subsidy portion for the applicants you're shopping for only.
If particular applicants don't use all of their premium subsidy, that overflow subsidy is applied to other applicants. This overflow subsidy is only visible once you get to the Confirm Plans page – it's not visible during shopping.
If the primary applicant's plan qualifies as a referral, all plans chosen will refer. If it doesn't, then none will. This is necessary because CMS only allows a single AOR per application.
Here are how certain rare scenarios are handled:
People who live in different zip codes can’t shop the same plans, and therefore can’t be in a group together.
Some plans have special rules that prevent certain people from being in the same group. For example, some may require that applicants reside together to be in a group together. In these cases, we’ll just split them into different groups automatically, while still allowing them to enroll in the plans. If this happens, you'll see it in the groupings that show on the Confirm Plans page.
If you want to use Multiple Enrollment Groups on an application, you can't choose a Catastrophic plan for anyone on the application. This is a CMS rule.
If you're enrolling people in a group where some people qualify for CSR and other's don't, then the whole group won't get a CSR – this is a CMS rule. To avoid this, either enroll each applicant in a different plan, or uncheck the "Group applicants who are on the same plan." checkbox (noted above).