On September 26, the Department of Health and Human Services (HHS)
released the final applications that individuals will use to apply for coverage
on the new Health Insurance Marketplace/Exchange beginning October 1. The
applications are posted on the Centers for Medicare and Medicaid Services (CMS)
website.
These applications will be used in all states with federally
facilitated or state partnership Marketplaces. The applications for state-run
Marketplaces may differ. The applications will be used both to apply for
coverage and to determine whether an individual or family is eligible for a
subsidy.
There are three different applications and instructions for each:
·
Individual Short Form – For single adults with no dependents who
are not eligible for employer health coverage and who want to determine if they
are eligible for subsidies.
·
Standard Form – For anyone who is eligible for employer health
coverage and wants to determine if they are eligible for subsidies.
·
Individual Without Financial Assistance – Form that can be used by
anyone who does not want to provide employment and income information to
determine if they are eligible for subsidies.
Beginning October 1, the forms can be completed online through www.healthcare.gov, or
paper forms can be submitted by mail.
What Employers Need to Know
The Standard application includes a section where individuals who
are eligible for employer-sponsored health coverage will need to provide
information about that coverage.
·
If the employer sent the Marketplace Notice –
including the optional page 3 – to all employees as required by October 1,
individuals will have all the information they need to complete that part of
the application.
·
If the employer did not send the Marketplace Notice or did not
include page 3 of the notice, the individual will not have all the information
needed to complete the application.
Page 2 of the Marketplace Notice includes basic information about
which employees and dependents are eligible for coverage. The optional page 3
indicates whether the individual receiving the notice is eligible for coverage
that meets the minimum value standard, the cost of employee-only coverage and
what changes the employer is planning to make for the next plan year.
The Standard application includes a section called the Employer
Coverage Tool, which individuals are instructed to take to their employer to
get the required information about their employer coverage. The Employer
Coverage Tool includes the same information as the Marketplace Notice. All
information in the Marketplace Notice and the Employer Coverage Tool is
numbered in the same way to make it easier for individuals to transfer the
information to the application.
The Application Process
All consumers will be directed to www.healthcare.gov to get
information about Marketplace coverage. They will have the opportunity to
answer a few questions about their age, the state where they live and whether
they currently have coverage. If they live in a state that has a state-run
Marketplace, they will be directed to their state Marketplace for more
information.
Individuals will complete an application to determine if they are
eligible for a subsidy and to review coverage details and premiums for the
plans for which they are eligible. They must enroll by December 15 for coverage
to be effective on January 1, 2014. The enrollment period will continue through
March 31, 2014.
Marketplace Application Checklist
According to a checklist
published on www.healthcare.gov,
individuals will need the following information to complete the application:
·
Social Security Numbers or document numbers for legal immigrants.
·
Employer and income information for every member of the household
who needs coverage – for example, pay stubs or W-2 forms.
·
Policy numbers for any current health insurance plans covering
members of the household.
·
Information about every job-based plan someone in the household is
eligible for, even if they are not enrolled in the plan.
Links to the Applications
Use these links to review the applications:
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