Module 7 Assistor Role and Requirements This module

Module 7: Assistor Role and Requirements

This module provides an overview of: • Your role as an Assistor • The requirements of being an Assistor • Goals of the Assistor program • How to remain neutral and non-biased when assisting consumers This module will help you understand your role and work effectively with consumers to ensure that they are getting health insurance coverage that meets their needs.

Section 1 Role and Requirements of Assistors

Assistors in NYS 9 000 R 2014 Assistors provide free, in-person enrollment assistance to consumers in New York State applying in the Marketplace and O L Employers E Assistors TRAINED Since May Individuals assistance to individuals and small business employers and employees

Assistor Role: Two Main Goals EDUCATE consumers on the Affordable Care Act (ACA) and the Health Plan Marketplace ASSIST consumers with completing their Marketplace application Outcome: In achieving these two goals, you will be helping ensure that consumers get the information and assistance they need to apply for and enroll in health care coverage that will meet their needs.

Assistor Requirements Click on each requirement to learn more. Meet Certification Requirements No conflicts of interest Comply with privacy Ensure consumers receive services in & security standards their preferred language Provide assistance in a neutral, non-biased way Provide service in an accessible way to consumers with disabilities

Section 2 Neutrality

Neutrality SIDE A OPINIO N B E D I S N O I N I OP

Providing Neutral Assistance • As an Assistor you need to: – Assist and educate in a neutral and non-biased manner – Never recommend or tell consumers to avoid specific plans – Educate consumers on tools to narrow their plan options Being neutral does not mean being uncaring

You are assisting Marcus with enrolling in a health insurance plan in the Marketplace. He has narrowed his options down to two plans. He asks you, based on what you’ve learned about him, if you can pick the plan that is the best for him. He wants to be sure he doesn’t make a mistake. What do you do? • • Do not recommend a plan. Find out about his health care needs and financial situation. Provide him with information to make a decision. “It’s important that you make this decision for yourself, but I am here to help you sort through the options. Based on what you’ve told me, it sounds like being able to continue seeing your provider is the most important thing to you. Let’s look at plans that your provider takes, and see if we can narrow down your options. ”

Marcus picks a plan that one of your good friends has. Your friend has had a terrible experience with it and is planning on switching out of it. What do you do? • Do not tell Marcus about your friend’s experience. • You are required to keep information you’ve heard about plans, good or bad, to yourself.

Marcus still isn’t sure which plan he should pick. He tells you that other than the occasional trip to see his primary care doctor, who he wants to stay with, he doesn’t anticipate accessing health services much. Can you assist him any further? Yes. You can help consumers: • Compare and contrast the benefits and costs of different plans • Find out if their providers are in the network of plans • Find out if their prescriptions are listed on formularies of plans • Compare the quality ratings of different plans

Assisting Consumers with Different Opinions of the ACA It is a requirement that you: • Remain impartial to consumers’ opinions on the ACA or the Health Plan Marketplace • Do not judge anyone’s opinion • Provide the best customer service possible, regardless of someone’s point of view.

Sharmaine has come in for assistance with enrolling in a health insurance plan. She seems irritated that she has to enroll in a plan and says to you “It is a pain that the government is making everyone get health insurance”. How would you respond? • Stay impartial and do not agree. • Move the conversation along. • “I hear that you are frustrated, and I understand that this can seem a little overwhelming. But there actually a lot of great options for health insurance on the Marketplace. How about we see if we can find one that would work for you? ”

Section 3 Practicing Neutral Assistance

Drag the best response to the Assistor. It is not fair that the government is forcing me to get health insurance I agree it is a pain that the government is making everyone get health insurance. You’re so wrong, and have no idea what you’re talking about. I can hear that you are frustrated by this. What I can do is to help you understand what plans and benefits you qualify for so that you can choose to enroll if you’d like.

Drag the best response to the Assistor. I want to find out if my HIV medication would be covered under Plan X. I don’t want to work with you because you might have HIV. Let’s take a look at the list of drugs that Plan X covers. I’ve never had anyone ask me about HIV medication before. Why don’t you call someone else?

Drag the best response to the Assistor. It is against my religion to have health care; can I get out of the program? What religion would ban health care? I think you should probably apply anyway to see if you are eligible for free care. You can apply for an exemption because of religious reasons, and if your exemption request is approved you could opt out of coverage and would not have to pay a fine for not having insurance. Having health care is important and could save your life. You need it.

Drag the best response to the Assistor. I am gay and want to find out if my spouse and I can get coverage. Let’s go through the eligibility determination process to find out which programs each you would be eligible for. I don’t approve of homosexuality. I’ll need to see your marriage certificate before I can help you.

Drag the best response to the Assistor. I am a healthy person and I don’t need health care. Unfortunately health has nothing to do with it. Well what if you got in a car accident? Or suddenly got sick? You would need it then. I think you need to sit here with me until you agree. I hear that you think you don’t need health insurance. However, when the ACA was created, it was created to let people buy different levels of insurance coverage. Shall we take a look at your options on the Marketplace?

Module Recap • In this module, you learned about – Assistor Role • Educate • Assist – Assistor Requirements • • • Meet certification requirements Comply with privacy and security standards No conflicts of interest Provide assistance in a neutral, non-biased manner Ensure consumers receive service in their preferred language Provide service in an accessible way to consumers with disabilities • Practice responding to consumers in neutral, nonbiased ways