Specifications include, but are not limited to: Provide Navigator services, including but not limited to, underserved communities in both urban and rural settings. Services in rural areas may be performed using telephone-based, internet-based, or in-person assistance. Ensure services target individuals who have been unable to take advantage of the availability of more affordable health insurance coverage through the Marketplace including those working multiple part-time jobs; self-employed individuals; and seasonal, hourly, contract and temporary employees. Assist Consumers with: Applications and enrollment; Verifications; Renewals; Health literacy and benefits education to support Consumer decision making and the utilization of health insurance coverage; Referrals, including to the Maine Bureau of Insurance, when necessary for complaints; Special enrollment periods (as determined by the Department) eligibility and applications; Appeals; and Any other enrollment processes/requirements as determined by the Department. Provide Affordable Care Act (ACA) education to Consumers, small business, and employees related to the Marketplace, including but not limited to: Rules related to the purchase of subsidized insurance through the Marketplace and eligibility for Medicaid, Children’s Health Insurance Program (CHIP), Medicare or other programs pursuant to 45 C.F.R. 155.210(e)(1). Education on the benefits of health insurance and what health insurance provides for Consumers and employers/employees. Explaining the health insurance terms, (i.e., aiding the Consumer to understand the difference between a premium, deductible, and co-insurance). Avenues to resolve disputes with insurance carriers, such as directing them to the Maine Bureau of Insurance, the Maine Attorney General Maine Health Insurance Consumer Assistance Program or referring enrollment disputes to the CoverME.gov call center. Culturally and linguistically appropriate health insurance education for populations served by the Marketplace, including individuals with limited English proficiency, those with disabilities and others, as per 45 C.F.R. 155.210(e)(5). Focusing on broad topics related to health insurance and coverage options, including through partnerships with other community-based organizations and/or community groups, and community leaders. Providing access to locations or mobile computing centers that facilitate access to CoverME.gov, the CoverME.gov call center, or provide the ability to print and mail hard copies of enrollment documents to CoverME.gov. Addressing questions regarding access to any of the enrollment methods and the submission of enrollment documentation to CoverME.gov. Explaining the eligibility criteria for purchasing health insurance through the Marketplace, enrolling in MaineCare and other State programs designed to provide medical coverage.
