Health Sherpa

[houcoogster]

Hello Ning,

How is healthsherpa doing these applications without the double redirect process legally?

You are saying that healthsherpa has direct integration with the federal data hub but in the documentation we received from CMS it says:

IRS regulations prohibit third party sites (such as those of Web Brokers and Issuers) from
accessing Federal Tax Information (FTI). This restricts the ability to seamlessly integrate the
eligibility application (even using web service calls to the FFM) as part of the shopping
experience on a partner website. Also, the process for determining eligibility for Medicaid,
CHIP, APTC, and CSR involves a complex UI workflow that is best implemented by the FFM.
Consequently, a consumer trying to enroll in a QHP through a partner website would need to be
transferred to the FFM to submit an eligibility application.

How is your process compliant?

Alex, this has been discussed ad nauseam on the forum. Use the search tool and get ready to read for days on end......

 

[STIBROKER]

Hello Ning,

How is healthsherpa doing these applications without the double redirect process legally?

You are saying that healthsherpa has direct integration with the federal data hub but in the documentation we received from CMS it says:

IRS regulations prohibit third party sites (such as those of Web Brokers and Issuers) from
accessing Federal Tax Information (FTI). This restricts the ability to seamlessly integrate the
eligibility application (even using web service calls to the FFM) as part of the shopping
experience on a partner website. Also, the process for determining eligibility for Medicaid,
CHIP, APTC, and CSR involves a complex UI workflow that is best implemented by the FFM.
Consequently, a consumer trying to enroll in a QHP through a partner website would need to be
transferred to the FFM to submit an eligibility application.

How is your process compliant?

 

[MedicareAgent]

I just put in an app and this popped up at the top of the page.

Important: Plans and prices for this state are for 2015. We are working on importing current plans as fast as possible. Current data is available for all federal marketplace states.

First time I saw this.

 

[ggiaco]

Hi folks, I'm Gerry - another member of the HealthSherpa team that will be actively going through the forums, responding, and surfacing items for our team. I sit a couple of desks over from Ning, who several of you will recognize.

Over the past few days we've been doing a bit more reading than commenting, but we're going to be posting a more detailed informational update soon, and hope to be more active/responsive moving forward.

Thanks for hanging with us! For a little bit of context, we now have over 10,000 FFM certified agent accounts, with hundreds being added and several thousand apps going through our service daily. Our team is working hard, but a bit stretched.

We know some of our highest volume users are active and vocal here. We appreciate you and your business. Please know that even when we don't get it right the first time, we're listening and will keep trying our best to do better. We're only successful in our company mission to help increase healthcare coverage if we can help you be successful yourselves.

Fortunately, recently we've been able to increase the size of our engineering team, and our development process allows for us to push multiple updates and improvements to the site on a daily basis as well.

 

[CHUMPS FROM OXFORD]

Welcome G. By the way, I have a shirt just like the one you're wearing on the Sherpa website.

We're looking forward to your active participation.

 

[STIBROKER]

Over the past few days we've been doing a bit more reading than commenting, but we're going to be posting a more detailed informational update soon

you can start here.......

http://www.insurance-forums.net/for...16-open-enrollment-t76187-40.html#post1051870

 

[ggiaco]

you can start here.......

Thanks. Circling back, linking to Ning's response to that concern in this thread:
EDIT: Can't post links yet.

"P.S. I did want to answer a few quick questions that came up earlier:

1) For ESI, if the wife is eligible but the husband is not, the spouse's portion of the premium is not subsidy-eligible. This is reflected in the quoter, and will be handled soon in the enrollment flow.

2) A small percentage of apps are receiving net premium differences - we are implementing a data sync process now to reduce these substantially.

3) The income change in the filler is due to rounding - our federal backend integration does not accept cents, so we are forced to round on submission, on a per person basis. We will put in a safeguard for folks near the Medicaid / CHIP boundaries going forward.
"

 

[TwoLabs]

What is ESI? Is that is referring to my question in the other thread then I am still confused.

If someone is eligible for group insurance through a spouse (and the cost of the EO is less than 9.56%) then they are not eligible for a tax credit at all. Currently Health Sherpa allows that person to go ahead and sign up, right?

 

[Ann H]

What is ESI? Is that is referring to my question in the other thread then I am still confused.

If someone is eligible for group insurance through a spouse (and the cost of the EO is less than 9.56%) then they are not eligible for a tax credit at all. Currently Health Sherpa allows that person to go ahead and sign up, right?

ESI is Employer Sponsored Insurance

It is true that the family glitch says that if husband and wife are eligible for Employer Sponsored Insurance that meets the affordable and adequate level, then the whole family is not eligible for subsidies. But I think that ggiaco (Gerry from Sherpa) was referring to a rare quirk where an Employer plan specifically says that spouses are not eligible. Legally, an employer can say that spouses are ineligible, but they cannot say that children are ineligible. However, it's rare that you find a case like that.

If that is truly what ggiaco meant, then it does not adequately address the situation that TwoLabs brought up in the other thread, which is this:

**Question here**

I may be wrong, but please correct me if so. It was always my understanding that if one has access to health insurance through a spouse's employer (regardless of the cost of the spouse), then they are not eligible for APTC? Is that right?

I had a gentlemen call me. He's currently on-exchange with BCBS of TX. Last year he applied directly with 1-800-healthcare. This year he's looking for some local advice.

So as I'm asking the questions, I ask if his wife is applying. He said no. I asked about her current insurance, "Oh she gets it through her job. But it's way too expensive to add me on there." So, this confused me. Shouldn't have the marketplace caught that when applying? He said no one ever asked him about that, only if his employer offered coverage, which they didn't.

So now, I go back and look through the Health Sherpa enrollment, and it doesn't ask either. You just go to the person applying for coverage, and the only question in reference to employers insurance is, "Does this person's employer offer health insurance?"

Not, "Does this person have access to employer sponsored health insurance either personally or through a spouse?"

Then you go to the "add other person" who is not applying for coverage, and there is no question about their insurance.

So, it looks like someone could 100% honestly sign up for health care on-exchange and get subsidies, while still having the opportunity to get health insurance through a spouses' employer. Someone enrolling themselves on healthsherpa would have no way of knowing the ACA rules about a spouse's job-offered coverage and the affordability rule.

What am I missing?

 

[nliang86]

Ann, we will update the language to ask about other family member's employers as well - thanks for pointing out the issue.