2015-2016 Toolkit for Enrollment Assisters

The information in this Toolkit is provided by the Tennessee Primary Care Association under a grant from the Baptist Healing Trust. Click on any link from the list below to view the related pdf document.

1. MAGI, Counting Income and Household Size

1.1 2015 Federal Poverty Levels
1.2 MAGI Under the ACA
1.3 MAGI
1.4 When to Count Dependent's Social Security - In the Loop
1.5 Counting Income
1.6 Tax Dependents - Children and Adults
1.7 How Are Households Determeined in Medicaid

2. Marketplace

2.1 Marketplace Application Checklist
2.2 Advanced Premium Tax Credits
2.3 How to Calculate PTC - CBPP
2.4 Reconciliation of APTCs
2.5 Exemption Instructions (Condensed)
2.6 Exemptions from the Health Insurance Marketplace Fee
2.7 Appeals and Complaints Chart - In the Loop
2.8 Marketplace Appeal Request Form
2.9 Marketplace Authorize Appeal Representative Form
2.10 What You Need to Know About Data Matching
2.11 ID Proofing and Info Inconsistencies
2.12 How Do I Resolve an Inconsistency?
2.13 Income Inconsistencies Tip Sheet (July 2015)
2.14 SEP Reference Chart
2.15 Special Enrollment Periods as of August 2015
2.16 Reporting Life Changes
2.17 Exemptions Handout
2.18 Affordability Exemption
2.19 Appeals - Eligibility and Health Plan Decisions

3. TennCare and CoverKids

3.1 Coverage Tip Sheets
3.2 TennCare Eligibility Flow Charts
3.3 Newborns Coverage Tip Sheet
3.4 Emergency Medicaid
3.5 TennCare Appeal Application
3.6 CoverKids Application - English
3.7 CoverKids Application - Spanish
3.8 TennCare Delays

4. Immigrant Eligibility

4.1 Immigrant Eligibility in Tennessee (Revised 7/21/15)
4.2 Overview of Immigrant Eligibility for Federal Programs
4.3 Immigrant Eligibility for Medicaid and CHIP and the Marketplace
4.4 Immigration Document Types
4.5 Citizenship Questions on Marketplace Application
4.6 Immigration Fast Facts
4.7 Immigration Brochure - TJC

5. Eligibility Flowcharts

5.1 Under 100 and 100-400
5.2 Employer Coverage Flow Chart
5.3 SSI and SSDI

6. Accessing Coverage and Care

6.1 Glossary of Health Coverage and Medical Terms
6.2 EHBs and Preventive Care Services
6.3 Coverage to Care - Sample EOB
6.4 Coverage to Care - Sample Insurance Card
6.5 Coverage to Care - Emergency Care
6.6 Getting Your Prescription Medications
6.7 How Cost Sharing Works

7. Privacy, Security and Ethics

7.1 Best Practices for Handling PII
7.2 PII and Obtaining Consumer Authorization
7.3 What is Fraud?

8. Resources

8.1 Overview of Cover Tennessee Programs
8.2 Behavioral Health Safety Net of Tennessee Eligibility Requirements
8.3 Behavioral Health Safety Net Providers
8.4 Long-Term Services and Suports and Medicare Savings Program Application
8.5 Employer Coverage Tool
8.6 Do's and Don'ts of Outreach
8.7 The Assister's Guide to Helping Employers Enroll in SHOP
8.8 Pregnant Women
8.9 Medicare and the Marketplace
8.10 2015 SHIP Brochure
8.11 COBRA
8.12 Coverage Options for Young Adults
8.13 Helpful Phone Numbers - TJC