Healthy San Francisco Application Assistor Eligibility Reference Manual Edition 6.2016 1 Website: www.healthysanfrancisco.org Edition: 6/2016 Prepared by Shelly Grimaldi, San Francisco Health Plan with contributions from the Training Lead Committee members. Email: [email protected] This reference manual was compiled by San Francisco Health Plan with sources from the HSF Enrollment & Eligibility Logic, the HSF Policies and Procedures, the One-E-App Reference Manual, and the HSF Participant Handbook. Other sources include the Healthy San Francisco Website and presentations prepared by the HSF Training Lead committee. 2 TABLE OF CONTENTS SECTION 1: PROGRAM HISTORY AND OVERVIEW ............................. 7 1.1 - History of Healthy San Francisco and Application Assistors ............................... 7 Purpose of the HSF Assistor Reference Manual ....................................................................................................7 Program Background & History ...........................................................................................................................7 Healthy San Francisco is NOT Health Insurance ....................................................................................................8 Administrative Partners & Roles .........................................................................................................................9 Role of the Application Assistor ........................................................................................................................ 10 1.2 - HSF Program Overview ............................................................................. 14 Eligibility Requirements .................................................................................................................................... 14 Medical Homes ................................................................................................................................................. 14 Overview of Accessible Services ........................................................................................................................ 14 Pharmacy Network ........................................................................................................................................... 15 Emergency Medical Transport Services .............................................................................................................. 15 HSF Program Costs ............................................................................................................................................ 16 SECTION 2: OVERVIEW OF ONE-E-APP ........................................... 18 2.1 - One-e-App: Healthy San Francisco’s Eligibility and Enrollment System ............ 19 Creating a One-e-App Account .......................................................................................................................... 19 Forgotten Password or Disabled Account .......................................................................................................... 19 2.2 - One-e-App Websites ................................................................................. 20 Live Site ............................................................................................................................................................ 20 Training Site ..................................................................................................................................................... 20 2. 3 - Troubleshooting and Bugs in One-e-App ..................................................... 21 One-e-App Help Desk ........................................................................................................................................ 21 Options when experiencing a bug ..................................................................................................................... 21 SECTION 3: COMPLETING AN ENROLLMENT .................................... 22 3.1 - Pre-Screen.............................................................................................. 22 Step 1: Determine if the applicant is renewing his HSF enrollment or if he is eligible for CityOption. ................... 22 Step 2: Residency within the City & County of San Francisco ............................................................................. 23 Step 3: At least 18 Years of Age ........................................................................................................................ 23 Step 4: Uninsured & Ineligible for other Health Coverage Programs .................................................................. 24 3 Step 5: 90-day Coverage Rule ............................................................................................................................ 26 Step 6: Calculating Household Income and Assets .............................................................................................. 26 Step 7: Verifications .......................................................................................................................................... 30 Step 8: Collect Documentation .......................................................................................................................... 31 3.2 Sign in to One-e-App ................................................................................... 32 One-e-App Tips ................................................................................................................................................. 33 One-e-App Vocabulary ...................................................................................................................................... 34 3.3 One-e-App How To… ................................................................................. 35 Begin a New Application ................................................................................................................................... 35 Verify an Address ............................................................................................................................................. 36 Direct a City Option Applicant ........................................................................................................................... 37 Add or Remove Household Members on the Application ................................................................................... 38 Add or Remove Household Income ................................................................................................................... 40 Interpret the..................................................................................................................................................... 43 Preliminary Eligibility Page ................................................................................................................................ 43 Generate the Universal Summary ...................................................................................................................... 45 Complete a Medical Home Selection ................................................................................................................. 46 Collect and Record Verification Documents ....................................................................................................... 49 Faxing Verifications .......................................................................................................................................... 54 Confirming HSF Enrollment ............................................................................................................................... 58 3.4 Healthy San Francisco Application Audits ....................................................... 60 3.5 Post Enrollment Participant Materials ............................................................. 61 Participant Materials Received at the Enrollment Appointment ......................................................................... 61 Approval Notice ................................................................................................................................................ 61 Next Steps Guide .............................................................................................................................................. 62 Other Forms ..................................................................................................................................................... 63 Participant Materials Received in the Mail ........................................................................................................ 64 3.6 Renewals and Application Modifications ......................................................... 65 Renewal Reminder Notices ............................................................................................................................... 65 Renewal Outreach Calls .................................................................................................................................... 65 Renewal Process ............................................................................................................................................... 65 3.7 Modifying an Application .............................................................................. 66 3.8 Disenrolling an Application ........................................................................... 67 3.9 Submitting Applications for other programs