AGENCIES
APPLICATIONS, FORMS AND WAIVERS
JOB AIDS AND TALKING POINTS
TRAININGS
SAMPLE NOTICES AND MEMBER COMMUNICATION
REGULATIONS AND POLICIES
- Mail/Fax Cover Sheet (May 2020)
- Navigator IDP Fax Sheet
- CAC IDP Fax Sheet
- Special Enrollment Period Form [English]
- Special Enrollment Period Form [Spanish]
- Fillable ACA-3 [English] (March 2022)
- Fillable ACA-3 [Spanish] (July 2021)
- SACA-2 [English] (March 2022) Fillable
- SACA-2 [Spanish] (July 2021) Fillable
- SACA-2 ERV [English] (July 2021) Fillable
- SACA-2 ERV [Spanish] (July 2021) Fillable
- Fillable Additional Person(s) English ACA-3 (March 2022)
- Fillable Additional Person(s) Spanish ACA-3 (July 2021)
- MassHealth Buy-In English (March 2022)
- MassHealth Buy-In Spanish (January 2022)
- Residency Affidavit [English]
- Residency Affidavit [Spanish]
- Zero Income Affidavit [English]
- Zero Income Affidavit [Spanish]
- Incarceration Affidavit [English]
- Incarceration Affidavit [Spanish]
- Job Update Form [English]
- Jon Update Form [Spanish]
- Additional Information about Your Access to ESI (October 2018)
- Non-Custodial Parent Form [English]
- Non-Custodial Parent Form [Spanish]
- MassHealth Adult Disability Supplement [English]
- MassHealth Adult Disability Supplement [Spanish]
- MassHealth Child Disability Supplement [English]
- MassHealth Child Disability Supplement [Spanish]
- MassHealth Medical Release Form [English]
- MassHealth Medical Release Form [Spanish]
- MassHealth Premium Hardship Waiver Form (04/18)
- MassHealth Third Party Liability Indicator Form
- MassHealth Buy-In Fillable [English] (July 2021)
- MassHealth Buy-In Fillable [Spanish] (March 2021)
- MassHealth Notice of Birth (NOB)
- 2019 Office of Patient Protection Open Enrollment Waiver Form
- Letter For Tax Preparer [Spanish]
- Third Party Liability Indicator
- Long Term Care Checklist
Job Aids:
- Release 24.0 Job Aid
- Categories of Afghan Immigration Statuses
- Open Enrollment 2022
- OE22 Talking Points
- Consumer Guide to Subsidies 2022
- ConnectorCare Shopping Guide in English
- ConnectorCare Shopping Guide in Spanish
- QHP Shopping Guide in English
- QHP Shopping Guide in Spanish
- ConnectorCare Carrier Lookup for 2022
- ConnectorCare Overview 2022
- Webinar Schedule
- Health Connector Health Plans Summary 2022
- Open Enrollment 2022 Training Scenarios
- Preliminary Subsidized Sample Notice 2022
- Preliminary Unsubsidized Sample Notice 2022
- MassHealth Eligibility Updates May 2021
- Assister Job Aid: Helping someone newly enrolled in Medicare OE21
- Open Enrollment 2021
- Updates to Minimum Essential Coverage (August 2020)
- Health Reimbursement Arrangements (August 2020)
- System Update 21 (August 2020)
- MassHealth Eligibility Flexibility Overview (June 2020)
- Where Can I Send Documents (May 2020)
- Assister Guidance
- DOI Bulletin on Coronavirus
- Optum ID changing to MA Login
- Tax Filing Options
- 2019 Tax Preparer Letter
- 2019 Tax Preparer Letter Spanish
- Assister Guide – Voter Registration
- Where Can I send Documents Fact Sheet
- Open Enrollment 2020
- ConnectorCare 2020 Enrollee Contributions
- ConnectorCare 2020 Benefit and Copay Chart
- QHP 2020 Standardized Plan Design
- Mixed Household Sample Notice
- Preliminary Renewal Sample Notice – ConnectorCare to Unsub
- Final Renewal Sample Notice
- Health Connector Renewal Insert
- ConnectorCare Overview 2020
- Guide to Subsidies – Spanish
- Guide to Subsidies – English
- QHP Shopping Guide – Spanish
- QHP Shopping Guide – English
- ConnectorCare Shopping Guide – Spanish
- ConnectorCare Shopping Guide – English
- Tufts- Atrius Talking Points
- Release 18.0 Job Aid
- Release 17.0 Job Aid
- CAC 2019 Certification FAQs
- Tax Forms and Reconciliation 2019
- Open Enrollment 2019:
- Connector Open Enrollment Call Schedule
- ConnectorCare Shopping Guide in English
- ConnectorCare Shopping Guide in Spanish
- 2019 ConnectorCare Overview
- QHP Shopping Guide in English
- QHP Shopping Guide in Spanish
- Consumer Guide to Subsidies in English
- Consumer Guide to Subsidies in Spanish
- Health Connector Health and Dental Plans 2019
- Qualified Health Plan Design for 2019
- ConnectorCare benefits and Co-pays
- ConnectorCare Enrollee Contributions by Region 2019
- Preliminary Eligibility Notice
- Eligibility and Renewal Notice
- Health Connector Redeterminations and Renewal Overview
- Helping Consumers Troubleshoot Connector Coverage
- Individual Mandate Consumer Guide
- Individual Mandate Key Points
- Health Connector Free Tax Preparation Information
- Health Connector Renewal and Shopping Insert
- Open Enrollment Poster (English)
- Open Enrollment Poster (Spanish)
- New MassHealth Plan Options:
- Continuity of Care FAQ
- Continuity of Care Memo
- Continuity of Care – Additional Member Supports
- MassHealth Health Plan Directory Tool (3/2019)
- MassHealth Health Plan Provider Directory Desk Guide
- ACO One-Pager (English)
- ACO One-Pager (Spanish)
- MassHealth Enrollment Guide (English)
- MassHealth Enrollment Guide (Spanish)
- ACO Notices At-a-Glance (An Assister Guide)
- ACO Letter A – ACO Partnership Plan Model (English)
- ACO Letter A – ACO Partnership Plan Model (Spanish)
- ACO Letter B – Primary Care ACO Model (English)
- ACO Letter B – Primary Care ACO Model (Spanish)
- ACO Letter C – MCO Administered ACO Model (English)
- ACO Letter C – MCO Administered ACO Model (Spanish)
- Letter AE – Auto-Assigned (English)
- Letter AE – Auto Assigned (Spanish)
- Letter PSP – Plan Selection Period (English)
- Letter PSP – Plan Selection Period (Spanish)
- Learn, Compare, Enroll Worksheet (English)
- Learn, Compare, Enroll Worksheet (Spanish)
- Enrollment Event Flyer (English)
- Enrollment Event Flyer (Spanish)
- Job Aid: Helping Someone Newly Enrolled in Medicare
- SHIP FAQ
- Job Aid: HIX Release 16.0
- Job Aid: HIX Release 12.0
- Job Aid: HIX Release 11.0
- MassHealth MCO Plan Selection & Fixed Enrollment Period FAQ
- FAQ for Transitioning Care when Switiching Health Plans
- CAC 2017 Recertification FAQ
- Assister FAQ for Open Enrollment 2017
- Open Enrollment 2017 Fact Sheet
- Enabling Protocols in Browsers
- Job Aid: HIX 9.0 Release
- Job Aid: HIX 8.1 Release
- Job Aid: RFI Generation/Experation Rules
- Job Aid: Reporting Multiple MassHealth ID
- MassHealth 2016 Renewal Guides (FAQ, Training Materials, and Sample Notices)
- 2016 – Assister Issue Reporting Form
- 2016 – Navigator Consumer Reporting Form
- System Release 7.2
- Job Aid: Account Linking for Assisters
- Job Aid: Shopping for Pediatric Dental Plans
- Auto Renewal Process
- Job Aid: EFT Portal
- Job Aid: Health Connector Payment Portal Tips
- Health Connector Applying and Shopping (11/2/2015)
- Release 7.0: Application Updates, Shopping Improvements & Provider Search
- Job Aid: Release 7.0
- HIX Updates – Release 6.0 (July 17, 2015)
- Electronic Funds Transfer (Updated 7/15)
- Multi-Household Shopping Job Aid
- Income Guide
- System Issues Log (Updated 11/21)
- Informational Support Guide
- ACA-3 Missing Critical Data (MCD) Guide
- Job Aid: ACA-3 Missing Critical Data (MCD)
- Required and Optional Forms for Assisters
- Where to Send Documents or Verification Information Tip Sheet (Updated 1/13)
Talking Points for Assisters:
- SHINE Counselor Talking Points for Connector Members that are Medicare Eligible
- Health Connector Bulletin 1-18 on Members Impacted by Gas Explosions
- Massachusetts State-Based Individual Mandate
- Talking Points on Presidential Election
- Open Enrollment Communication Description
- Free Help with Tax Preparation & Reconciliation of Tax Credits
- Talking Points on Letter to Potentially Medicare-Eligible Members
- March 2016 Talking Points
- Tax Information for Member with Overlapping Coverage – Talking Points
- February 2016 Talking Points
- January Messaging
- What to Expect – Taxes – Talking Points
- December Talking Points
- HSN Talking Points
- Auto Renewal Talking Points
- ConnectorCare in the Provider Search Tool
- Special Enrollment Period for Victims of Domestic Violence or Spousal Abandonment Talking Points
- November Messaging
- Bronze Letter Talking Points
- Medicare OE Talking Points
- Open Enrollment Talking Points
- Rate Changes Talking Points
- Shopping Talking Points
- Welcome Letter Talking Points
- Where to Get Help Talking Points
- October Messaging
- Denial Noticing Messaging (10/15)
- Renewal Noticing (10/15)
- September Messaging
- What to Expect for 2016 Talking Points
- Tax Filing for 2014 Talking Points
- August Messaging
- Corrected 1095-A Talking Points
- MassHealth Renewal Extension PowerPoint
- MassHealth Renewal Extension
- MassHealth Renewal Messaging
- MassHealth Renewal Plans for 2015
- January Messaging
- December Messaging
- November Messaging
- Additional November Messaging
- Open Enrollment Packet Talking Points
- Open Enrollment Messaging
- Paper Applications
- Plan Renewal and Discontinued Talking Points
- Qualified Health Plans (QHP) Termination
- Temporary MassHealth
ACA Learning Series:
- Medicare Savings Program Expansion December 2019
- MassHealth Health Plan Enrollment Form Updates (10.2019)
- Health Connector Redeterminations, Renewals and Open Enrollment 2019 Overview
- Health Connector Scenarios for Open Enrollment 2019
- Changes to MassHealth Provisional Eligibility
- Health Connector and Mixed Household Redeterminations, Renewals, & Release 9.0
- MassHealth 2016 Renewals Training
- Health Connector & MassHealth: Year-End Tax-Filing Process
- How to Enroll in a MassHealth Plan
- Medicare Open Enrollment
- Health Connector Redeterminations and Renewal Update
- MA Health Connector Seal of Approval Process
- How to Shop & Select a Health Connector Plan
- MassHealth Renewal Plans 2015
- Special Enrollment Periods (SEPs)
- Marketplace and MassHealth Coverage at Tax Time
- Member Transition 2014-2015
- ACA Transition Toolkit
- Member Transition
- MA Health Connector Seal of Approval
- Employer Sponsored Insurance (ESI)
- Affordable Care Act (ACA) 101
- Modified Adjusted Gross Income (MAGI)
- Federal and State Subsidies through the Health Connector
MTF Meetings
- SPRING 2021
- WINTER 2021
- OCTOBER 2020
- JULY 2020
- APRIL 2020
- JANUARY 2020
- OCTOBER 2019
- JULY 2019
- APRIL 2019
- JANUARY 2019
- OCTOBER 2018
- JULY 2018
- APRIL 2018
- JANUARY 2018
- OCTOBER 2017
- JULY 2017
- APRIL 2017
- JANUARY 2017
- OCTOBER 2016
- JULY 2016
- APRIL 2016
- JANUARY 2016
- OCTOBER 2015
Sample Notices:
- Nantucket and Oak Bluffs MassHealth PSP Notice 1.2020
- Premium Assistance Brochure
- Equitable Relief for Medicare eligible enrolled through Marketplace
- Medicare Eligible Letter 2019
- Health Connector Preliminary Eligibility Notice
- Health Connector Final Eligibility and Renewal Notices
- MassHealth Termination Notice for Duplicate Account
- Health Connector Termination Notice for Duplicate Account
- Termination Notice: No Response to Job Update
- Termination Notice: No Response to ESI From
- Termination Notice: Duplicate Account Closing
- Transitional Medical Assistance Notice
- HSN Renewals for Medicare Members Cover Letter
- MCO Fixed Enrollment Confirmation Notice
- Mixed Household Renewals
- Health Connector Late November and Early December Member Communication Samples
- Sample Mixed Household Redetermination/Renewal Cover Letter
- HSN & ConnectorCare Unerolled Sample Letter
- Job Update Form & Notice
- MassHealth (Approval, Denial and Provisional Notices)
- Notice Overview and Logic
- Health Connector Eligibility Approval
- Health Connector Eligibility Denial
- Health Connector Request for Information (RFI)
- Health Connector Request for Identity Proof (RIDP)
- CommCare Extension Letter [English]
- CommCare Extenstion Letter [Spanish]
- Medical Security Program (MSP) Extension Letter
- Renewal notice for Seniors and People Seeking Long-term Care Services
Member Communication:
- English Medicare Savings Program 1/2020
- Spanish Medicare Savings Program 1/2020
- Portuguese Medicare Savings Program 1/2020
- Haitian Medicare Savings Program 1/2020
- Chinese (Traditional) Medicare Savings Program 1/2020
- Chinese (Simplified) Medicare Savings Program 1/2020
- Vietnamese Medicare Savings Program 1/2020
- Individual Mandate Consumer Guide
- Health Connector College Graduate Poster
- Health Connector Young Adult Poster
- SHIP Student Flyer FAQ
- Health Connector Tax Communications
- Delay in February Enrollment Bills
- Open Enrollment Sample Notices
- MassHealth Premium Assistance for Student Health Insurance Program (SHIP) Flyer
- CMSP Pharmacy
- Unemployment Options Flyer
- Subsidized Tax Filing Flyer
- Unsubsidized Tax Filing Flyer
- OE Communication Calendar (2016)
- ConnectorCare Consumer Shopping Guide
- Health Plan Consumer Shopping Guide
- CommCare & MSP Termination with New Health Insurance
- CommCare & MSP Termination and Needs to Apply
- 01/23/15 Deadline Reminder Postcard
- Not Enrolled Postcard Reminder
- CommCare – Open Enrollment Packet
- MSP – Open Enrollment Packet
- Qualified Health Plans (QHP) – Open Enrollment Packet
- Open Enrollment Flyer
- Qualified Health Plans (QHP) Open Enrollment Postcard [English]
- Qualified Health Plans (QHP) Open Enrollment Postcard [Spanish]