The 14 state based Marketplace platforms must ensure customers can enroll during the Special Open Enrollment Period April 1st – April 30th (for Connecticut residents). The Feds will be doing the same preparation supporting 37 states (1).
Your organization likely has already taken many of the steps below. However, we all know what they say about ‘assumptions…’ It’s best to double check and validate your organization is truly prepared.
Below is a good checklist with questions to ask your leaders, validating your open enrollment approach is stable.
Checklist for Special Open Enrollment (SEP)
1. Security – if there is a security breach or violation, what is the escalation approach? If you ask two random staff members are they clear on the procedure, or are only a few people briefed?
2. Business Validation – how is business validation being conducted and when does that occur? Which mock business scenarios are being executed to ensure critical functionality works as planned?
- Business Health Check– how are business process changes communicated internally and through the call center to ensure reps are communicating consistently?
- Technical Health Check – is there a playbook for a morning system health check including ETL, databases, application servers, HTTP servers, shared services/ Federal Data Services Hub, batch, rules and notice generation? Do we have a process to generate hourly exception reports highlighting issues with the Federal Data Services Hub before our customers notify us?
3. Training and Education – is the field staff trained and clear on the conditions of who can enroll during this special period? What training have in-person assisters, brokers, internal staff, call center staff and operations had to prepare?
- Health Insurance Terminology – where do members of your organization go for the answer to ‘what does this mean?’
- Enrollment Paths – are folks clear on when to use which path to enroll customers? For example, APTC quick flow, leveraging the call center or when to lead a customer towards in-person assistance at a store or benefit center?
- Coverage Dates – does the staff know what date and time you must have enrolled by to have May 1st effective healthcare coverage? When do insurance plans expire for customers?
4. Reporting Enrollment Numbers – how are we doing to report numbers to CMS/CCIIO? What is the frequency and who’s on point (2)?
- Expectations of Analytics – have you communicated to CMS/CCIIO what enrollment numbers will be communicated, when?
5. Issue Communication – when there are issues, and there will be issues, how does the team communicate? An escalation bridge? Command center calls or just a flurry of emails? The approach should be consistence and have a cadence for communication frequency. How are new issues logged and triaged? If a team member is made aware of an issue-now what? How do vendors report issues? What is the chain-of-command to ensure those issues are presented, logged and addressed?
- System Change Requests – how are system changes requests handled? How do we loop back to the requestor with new information when made available?
- Carriers – what is the communication process to carriers? Is it the same as normal? What is normal anyways? How are carriers communicating issues regarding reconciliation and member enrollment?
6. Identify Hard Stops – have you identified where the hard stops are in your application flow? For example if the FDSH identify proofing service goes down, can customers use a secondary service or are they stopped dead? If the income services from FDSH times out, now what? The effectiveness of your decisions are primarily based on the quality and timeliness of the information from which you’re making decisions. Establish a clear plan to move information quickly to the resource making decisions.
7. Media Strategy – when and how does information go to the media to ensure the state is proactive with positive information and gets ahead of challenges as they arise?
8. Ancillary Products – for dental and vision etc. has a business and system process been setup to support this open enrollment period? Who do customers call? How do escalations occur? I’ll take liberty and bucket SHOP in here as well. How are employers notified? What communication is going to newly enrolled employees?
Lastly what type of website and IVR messaging is being setup to help funnel customers down the right path? Are you adding a banner to the website, changing the initial IVR message?
Although there were not excessive system changes required for this Special Open Enrollment Period, setting up a daily command center call, is a good idea to ensure leaders have equal awareness of new challenges.
Centers for Medicare & Medicaid Services. (2015). Getting 2015 coverage with a Special Enrollment Period. Retrieved from https://www.healthcare.gov/coverage-outside-open-enrollment/special-enrollment-period/
Department of Health and Human Services Office of the Assistant Secretary for Planning and Evaluation. (2015). Health Insurance Marketplaces 2015 Open Enrollment Period: March Enrollment Report (pp. 1–73). Retrieved from http://aspe.hhs.gov/health/reports/2015/MarketPlaceEnrollment/Mar2015/ib_2015mar_enrollment.pdf
DRUMMOND, K. (2012). Image Source. Retrieved from http://www.prevention.com/health/health-concerns/new-checklist-help-early-ovarian-cancer-diagnosis