Citizens can also apply to purchase health care for their themselves and their families without seeking financial assistance. As with other application processes, a citizen account is required in order to purchase health care plans directly. Once the user is logged in, an application script captures the necessary information which is a subset of the information required when applying for assistance. To be eligible to purchase a health plan in the exchange, individuals must meet certain non-financial requirements. The applicant and members of their household applying must satisfy state residency, citizenship/lawful presence requirements and not be incarcerated.
Eligibility is determined for each household member results displayed using the same HCR eligibility results page that is used in the application for assistance. A successful determination allows the applicant to continue to shop for plans in the exchange.
Plan selection, shopping and enrollment follows the same process in the plan management system to that for an individual selecting having applied for and been found eligible for assistance. Summary demographic and eligibility information is passed to the plan management vendor and is used in plan selection and enrollment. The key difference in this flow is that there is no tax credit or cost-sharing reduction information associated. As a result the plan management system does not need to adjust any monthly premiums, nor ask any questions related to how much of the tax credit is to be used. Upon completion, enrollment summary information is returned to Cúram and displayed on HCR eligibility results.
Alignment with the application for assistance ensures that ongoing case management is identical - the intake process can begin upon completion of enrollment.