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Illinois Comprehensive Health Insurance Plan
Pat Quinn, Governor
Andrew Boron, Chairman of the Board of Directors
Melissa Hansen, Executive Director
A State health insurance program for Illinois residents

+ Administrators
Blue Access for Members (Medical)
Catamaran (Pharmacy Benefit Manager)

Affordable Care Act Survey Frequently Asked Questions

Several questions have been submitted as a result of the survey that was sent in August to solicit your comments about the impact the Affordable Care Act (ACA) may have on active ICHIP Plan members. We have listed the most common questions about the ACA and your ICHIP coverage, and our responses below. In many instances, we simply do not have the answers yet, and may not know more specific details until after the changes due to ACA are actually implemented. The responses contained herein represent our best understanding of the new Health Insurance Marketplace (hereinafter referred to as the “Marketplace” and formerly known as “Exchanges”) at this time. We will update these answers as more is known about the ACA. (Updated 10/03/13)

  1. Questions Specifically Related to your ICHIP Coverage and the ACA
    1. Will I be able to obtain the same level of coverage that I currently have at a lower cost?
    2. Why do I have to obtain new coverage?
    3. I am concerned about breaks in coverage or transition of coverage.
    4. I am on Medicare. Can I enroll in Marketplace coverage?
    5. I currently have my premiums paid by the HCTC program. Will this program continue? What are my options?
    6. I am concerned about potential problems with the Marketplace.
    7. I am concerned about enrolling in a new plan.
    8. Will I be forced to disclose that I am coming to the Marketplace from high-risk insurance; and, if so, will that impact my ability to obtain coverage in the Marketplace?
    9. If I keep my ICHIP coverage for part of the new year, will I be able to carry over the amounts used to satisfy my deductible and out-of-pockets to any new coverage that I might acquire in mid-year?
    10. I have just recently started a treatment plan that will carry over into next year. Will I be able to keep my ICHIP coverage until that treatment plan is completed?
    11. I am currently enrolled in a high-deductible health plan and have a corresponding Health Savings Account (HSA) with my bank. Will I be able to continue to maintain my HSA when these changes take place?
    12. Will ICHIP set up offices state-wide to accommodate members who would like to have a face-to-face conversation about their options?
    13. Which "metal" level plan does my current ICHIP coverage equate to?
    14. If I enroll in a plan through the Marketplace . . .
  2. General Questions about the Affordable Care Act
    1. How long will it take to complete the application process under ACA?
    2. How much documentation will I need to provide or how difficult will it be to obtain any documentation that is requested during the enrollment process? Will I have to answer health questions?
    3. Can coverage be denied or delayed based on my pre-existing condition(s)? Can I be charged a higher premium based on my pre-existing condition(s)?
    4. What enrollment options will I have?
    5. Will the new coverage available under the ACA be portable? I am considering moving out of state in the near future and wonder if I can take the new coverage with me when I move.
    6. I need:
      • office visits
      • hospitalizations and/or ER visits
      • prescription drugs
      • brand-name prescriptions
      • MS prescriptions
      • transplants
      • acupuncture
      • chiropractic care
      • physical therapy and/or rehab
      • routine care
      • flu shots and other vaccines
      • mammograms
      • mastectomy products
      • diabetic supplies
      • mental health benefits
      • alternative medicine
      • "experimental therapies”
      • -ostomy supplies
      • orthotics
      • lab work and other tests
      • dental and vision care
      • hearing loss benefits
      Are they covered?
    7. My doctor is recommending surgery. Should I put off having the procedure done until I can transition over to new coverage?
    8. Is there a chance that information/choices/rates will change between the time the Marketplace first opens and the time coverage takes effect? Are insurance companies locked into what is offered and the price that will be charged until next open enrollment? Or, can the options/prices change in 2014?
    9. Is this new coverage in the Marketplace a governmental program like Medicare or Medicaid?
    10. What coverage choices will I have?
    11. Is it true that the government will now decide whether to approve a treatment option that has been recommended by my physician? Will there be “panels” or review boards who dictate whether or what type of treatment I receive or will there be any sort of health care rationing?
    12. How will I know what plan to choose? Will someone be available to help me decide or recommend the best choices of coverage for me to choose from?
    13. I will be out of the country during open enrollment. How can I enroll?
    14. If I have a life event in 2014 that will change my insurance needs, such as:
      • change in marital status
      • change in dependent status
      • becoming eligible for Medicare
      • losing employer insurance coverage
      Will I be able to make a change in coverage due to this life event after open enrollment ends on March 31, 2014?
    15. Computers and the Internet
    16. Who do I contact to begin enrollment? Will customer service be available? How easy will it be to speak to a live person?
    17. I thought the ACA was overturned by the Supreme Court?
    18. How secure will the information be that I provide?
    19. How knowledgeable will the “navigators” and “in-person assisters” be of the new provisions?
    20. What protections will I have that the premium rates will not increase dramatically the year following implementation (2015)?
    21. Will the number of people able to enroll in these new plans be limited?
    22. If I obtain coverage and am not happy with it, will I be able to change? If so, will I have to wait until the next open enrollment period?
    23. Will family coverage be available?
    24. Who will be the insurance companies offering coverage in the Marketplace?
    25. Will insurance companies who are allowed to sell coverage be vetted and approved by some sort of oversight agency?
    26. What assurances do I have that, once I am insured, the insurance company will not find a way to terminate my coverage?
    27. Will there be plans available that include maternity coverage? Can I opt out of maternity coverage since I do not plan to become pregnant?
  3. Questions about Medicaid
    1. Will I be forced into Medicaid and lose my doctor?
    2. If coverage is based on income, will I have to change coverage if my income changes?
    3. Who do we turn to if we have problems paying the insurance premiums?

Questions Specifically Related to your ICHIP Coverage and the ACA

Q1.              Will I be able to obtain the same level of coverage that I currently have at a lower cost?

Response: We do not know yet whether you will find coverage sold at a base rate equivalent to that which you currently pay for your ICHIP coverage. This information will not be known until October 1, 2013. We anticipate that ICHIP rates will always be higher than coverage available through the Marketplace or directly from insurance companies.   ICHIP’s rates are required by law to be greater than what private insurance company’s charge.   We anticipate that our rates will be increasing some time in early 2014. This means that even if you stay on your current ICHIP plan, it is likely that your rates will increase. If you apply for a silver plan of coverage through the Health Insurance Marketplace and you do not have other coverage available through an employer, you may qualify for premium tax credits and cost-sharing reduction subsidies that are available only through the Marketplace.

So that you can comparison shop more effectively, coverage in the Marketplace will be sold based on its “metal level” equivalency. Generally speaking, the following metal levels will be sold:

Level:

*Description of coverage:  On average,

The premium cost will be:

Bronze

Your plan pays 60%. You pay 40%.

Lower than any other metal level

Silver

Your plan pays 70%. You pay 30%.

Higher than a Bronze level, but lower than a Gold or Platinum level

Gold

Your plan pays 80%. You pay 20%

Higher than a Bronze or Silver level, but lower than a Platinum level

Platinum

Your plan pays 90%. You pay 10%.

Higher than any other metal level

*The reference to the amount that the plan pays and the amount that you pay is not a reference to coinsurance levels.   Instead these cost-sharing figures are approximate, and apply to cost sharing to the plan as a whole. Your costs for individual services will vary.

Although premium tax credits are available for any type of plan if purchased through the Marketplace to those who qualify, it is our understanding that cost-sharing subsidies that may be able to be used to reduce out-of-pocket costs are only available on silver plans. It is not known whether all metal levels will be available in your area. You should be able to check the Marketplace on or after October 1, 2013 to determine which metal level plans will be offered in your area.
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Q2.              Why do I have to obtain new coverage?

Response: The ICHIP Board is encouraging all ICHIP members to consider purchasing coverage through the Marketplace or through an insurance company because the coverage should be more reasonably priced with generally better coverage. At this time, only the Medicare plans and the HCTC plans are ending. However, our Board encourages you to explore your options, as it is in your best interest to investigate all of your other options.

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Q3.              I am concerned that my ICHIP coverage will end before I have a chance to enroll in other coverage or that I will have a breakin coverage. What if Marketplaces are not fully functional on time or if I do not apply in time to have coverage effective January 1, 2014? How long will ICHIP remain in place? Are my doctor appointments in October, November & December covered? If so, by whom, ICHIP or new coverage?

Response: Except in certain instances described below, your ICHIP coverage will NOT be terminated on December 31, 2013. At this time, no specific termination date has been set for members enrolled in the Traditional Plans 3 or W (identified as group # “00PCHP” and “00PCDP”) or the HIPAA Plans 5 or X (identified as group “00PHPA” and “00PHDA”).

Regardless of which coverage plan you are currently enrolled under, you will receive a non-renewal notice prior to coverage ending.  

Traditional Plans 3 and W and HIPAA Plans 5 & X: These plans will NOT be terminated on December 31, 2013. A specific notice will be sent to those enrolled in these plans should a decision be made to terminate coverage.

Plan 2: Medicare carve-out plan: It is true that coverage will end on December 31, 2013 if you are enrolled in the Medicare carve-out plan (referred to as “Plan 2” or identified as group # “00CHIP” coverage). Plan 2 members are people who are enrolled in Medicare. Medicare is not affected by the Marketplace. Plan 2 members are encouraged to take advantage of the Medicare Open Enrollment period that runs from October 15, 2013 through December 7, 2013, for a January 1, 2014 effective date.

Plans P, T, Y and Z: HCTC Plans: The federal Health Coverage Tax Credit (HCTC) will end on December 31, 2013. Specifically, this applies to coverage under the HCTC plans P, T, Y and Z (identified as group # “00PHPB”, “00PHDB”, “00PHPC”, AND “PHDC”).   Since this tax credit will be ending, coverage under these specific plans will also end. Although coverage under HCTC plans will end on December 31, 2013, effective January 1, 2014, persons enrolled in these HCTC plans will be moved to the corresponding 00PHPA or 00PHDA HIPAA plans, based on the deductible option under which they are currently enrolled. Should you enroll in coverage elsewhere, please let us know so that your ICHIP coverage can be terminated.

As you can see, in many instances the ICHIP program will persist, at least for the short term. That being said, we still encourage you to explore your options, as it is in your best interest to investigate all of these other options. Top

Q4.              I am on Medicare. Can I enroll in Marketplace coverage?

Response: No. Persons on Medicare will remain on Medicare. Medicare is not part of the new Health Insurance Marketplace. Persons enrolled in Medicare do not need to buy a Marketplace plan. For more information, refer to www.medicare.gov and type in the search word “marketplace”.
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Q5.              I currently have my premiums paid by the HCTC program. Will this program continue? What are my options?

Response: The federal Health Coverage Tax Credit (HCTC) will end on December 31, 2013. Since this tax credit will be ending, coverage under your HCTC plan will also end. Although coverage under HCTC plans will end on December 31, 2013, persons enrolled in these HCTC plans will be moved to the corresponding HIPAA plan, based on the deductible option under which they are currently enrolled, effective January 1, 2014. Should you enroll in coverage elsewhere, please let us know so that your ICHIP coverage can be terminated. It is important to note, however, that the premium you will pay for this new coverage will be significantly higher than what you are paying now with the tax credits that will be expiring.
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Q6.              What happens if the Marketplace is not up and running as planned? What will happen if I enroll in a new plan and then the federal government changes the law or defunds ACA? Will ICHIP still be an option? Will the companies be able to terminate my coverage and then I will be left with nothing?

Response: At this time there is no indication the Marketplace will not be available on October 1, 2013, although we do understand that certain aspects of the Marketplace might be delayed (such as the Spanish version of the main website and certain delays for small businesses). No legislative action has been taken to repeal or sunset the ICHIP Act. Therefore, ICHIP may remain an option at this time.
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Q7.              Will I automatically be moved to one of the new plans? Will ICHIP be providing my contact information to all available insurance companies so that I will get solicitations via phone/mail from these potential companies? Since Blue Cross Blue Shield is the company for the ICHIP program now, will you be sending material on what will be available through them?

Response: ICHIP will not give out your personal information. ICHIP is required by applicable federal and state law to maintain the privacy of your protected health information, which includes information such as your name and address. ICHIP does not share your information with anyone without a specific authorization to do so. Blue Cross Blue Shield will be prohibited from using our membership list as a mailing list to send you material. You must apply for coverage either through the Marketplace or directly to an insurance company or licensed insurance producer (a person who is licensed by the state to sell insurance policies). You will not be eligible for any financial assistance unless you apply through the Marketplace. It is also important that you advise us in writing if you do obtain coverage elsewhere as we will not be notified by the Marketplace that you have obtained other coverage. For your convenience, we have a form on our website at www.chip.state.il.us/download.htm entitled “Form for Active Members to terminate their CHIP coverage” that can be used to inform us once you have been able to enroll in other coverage.

It is our understanding that if you are eligible for Medicaid (sometimes referred to as Public Aid, medical assistance or medical card), or the Children’s Health Insurance Program (sometimes referred to as the All Kids Share or Premium programs) you will be enrolled automatically and may not have to wait until January 1, 2014 for Medicaid or Children’s Health Insurance Program coverage to take effect. You cannot be enrolled in ICHIP and Medicaid at the same time. Your ICHIP will be terminated as of the date that your Medicaid coverage becomes effective and any claims that may have been paid by ICHIP for services incurred after Medicaid takes effect will be recovered by ICHIP. It is our understanding that as you proceed through the Marketplace on-line application process, if it appears that you will meet Medicaid eligibility, you will be asked if you would like help paying for medical bills from the last 3 months. If you answer “yes”, your Medicaid coverage may be backdated. If this happens, you will lose your ICHIP coverage as of the date that Medicaid coverage was available. This is especially important if you used providers that do not accept Medicaid or obtained prescription drugs that do not meet Medicaid requirements, since you will have to refund ICHIP for any claims paid by us for those services.
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Q8.              Will I be forced to disclose that I am coming to the Marketplace from high-risk insurance; and, if so, will that impact my ability to obtain coverage in the Marketplace?

Response: It is our understanding that, depending on how you answer certain questions on the application, you may be asked whether you currently have health insurance coverage. One of the options to choose from may be listed as “CHIP”. Please note that this refers to the Children's Health Insurance Plan, not ICHIP. Another option is “Other” and asks you to provide the name of the health insurance. It would be appropriate for you to disclose “ICHIP” or “Illinois Comprehensive Health Insurance Plan” as the name of the other coverage in this area. Providing this information should not impact your ability to obtain coverage in the Marketplace, since you cannot be turned down or charged a higher premium based on health.
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Q9.              If I keep my ICHIP coverage for part of the new year, will I be able to carry over the amounts used to satisfy my deductible and out-of-pockets to any new coverage that I might acquire in mid-year?

Response: It is unlikely that your new insurance company will allow this. You will need to carefully review the insurance options that will become available in the new year. We encourage you to ask the new insurance company this question. You may wish to seek the assistance of a licensed insurance producer (a person who is licensed by the state to sell insurance policies) to assist you with this process.
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Q10.          I have just recently started a treatment plan that will carry over into next year. Will I be able to keep my ICHIP coverage until that treatment plan is completed?

Response: The answer depends on which ICHIP plan you are currently enrolled in. In many instances, the ICHIP program will persist, at least for the short term. That being said, we still encourage you to explore your options, as it is in your best interest to investigate all of these other options. It will be particularly important for you to find out if your providers, services and medications will be covered by the new plan. We encourage you to ask the new insurance company this question. You may wish to seek the assistance of a licensed insurance producer (a person who is licensed by the state to sell insurance policies) to assist you with this process.
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Traditional Plans 3 and W and HIPAA Plans 5 & X: These plans will NOT be terminated on December 31, 2013. At this time, no specific termination date has been set for members enrolled in the Traditional Plans 3 or W (identified as group # “00PCHP” and “00PCDP”) or the HIPAA Plans 5 or X (identified as group “00PHPA” and “00PHDA”). A specific notice will be sent to those enrolled in these plans should a decision be made to terminate coverage.

Plan 2: Medicare carve-out plan: It is true that coverage will end on December 31, 2013 if you are enrolled in the Medicare carve-out plan (referred to as “Plan 2” or identified as group # “00CHIP” coverage). Plan 2 members are people who are enrolled in Medicare. Medicare is not affected by the Marketplace. Plan 2 members are encouraged to take advantage of the Medicare Open Enrollment period that runs from October 15, 2013 through December 7, 2013.

Plans P, T, Y and Z: HCTC Plans: The federal Health Coverage Tax Credit (HCTC) will end on December 31, 2013. Specifically, this applies to coverage under the HCTC plans P, T, Y and Z (identified as group # “00PHPB”, “00PHDB”, “00PHPC”, AND “PHDC”).   Since this tax credit will be ending, coverage under these specific plans will also end. Although coverage under HCTC plans will end on December 31, 2013, effective January 1, 2014, persons enrolled in these HCTC plans will be moved to the corresponding 00PHPA or 00PHDA HIPAA plans, based on the deductible option under which they are currently enrolled. Should you enroll in coverage elsewhere, please let us know so that your ICHIP coverage can be terminated.
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Q11.          I am currently enrolled in a high-deductible health plan and have a corresponding Health Savings Account (HSA) with my bank. Will I be able to continue to maintain my HSA when these changes take place?

Response: We currently do not have information available as to the types of plans that will be available in the Marketplace. We recommend that you check with your insurance producer (a person who is licensed by the state to sell insurance policies), an insurance company or the Marketplace on or after October 1, 2013 to see what is available in your area.
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Q12.          Will ICHIP set up offices state-wide to accommodate members who would like to have a face-to-face conversation about their options?

Response: At this time there are no plans to set up offices state-wide.  The Board office is located at 320 W Washington, Springfield, IL. We are available by phone 800-962-8384. Our hours of operation are 8:00 to 4:30, Monday through Friday. Should you desire a face-to-face discussion, we encourage you to call to make an appointment ahead of time to ensure that staff will be available to meet with you.
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Q13.          Which metal level plan does my current ICHIP coverage equate to?

Response: Although ICHIP is considered essential health coverage for 2014, we have not performed this analysis. We encourage you to comparison shop based on the needs of your family and budget.
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Q14.          Will my ICHIP coverage automatically terminate if I enroll in a plan through the Marketplace? Do I have to wait for my renewal date to cancel my ICHIP coverage? Will ICHIP charge me any penalties for cancelling effective 1/1/14?

Response: Your ICHIP coverage will not automatically terminate. You will need to let us know in writing that you want to terminate your ICHIP coverage, should you obtain other coverage. For your convenience, we have a form on our website at www.chip.state.il.us/download.htm entitled “Form for Active Members to terminate their CHIP coverage” that can be used to inform us once you have been able to enroll in other coverage. You do not have to wait until your next renewal date to cancel your ICHIP coverage. Your coverage will be terminated on the date we receive your request to terminate or on a future date that you specify. Once coverage has ended, we will calculate the amount of premium refund that is due. You will not pay a penalty for canceling your ICHIP coverage.
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II.               General Questions about the Affordable Care Act

Q15.          How long will it take to complete the application process under ACA?  

Response: The amount of time you spend completing the application will depend on whether you are applying for yourself or multiple family members. In addition, if you are trying to determine if you will qualify for help with paying your premiums or other costs, you can expect to have to provide certain financial information.   The Health Insurance Marketplace indicates that they are still finalizing certain details and at this time they cannot give an estimate of the average amount of time it will take to complete the application.

Our understanding is that if you apply on-line through the Health Insurance Marketplace, in most instances, your information can be verified in “near real-time”. If you apply “on paper”, you will need to allow more time.If you are applying outside the Health Insurance Marketplace (by going directly to an insurance producer, a person who is licensed by the state to sell insurance policies, or an insurance company’s website, for example), it will depend on the insurance company.

The advantage of using the on-line Health Insurance Marketplace is that there is a single set of questions that determines your eligibility for multiple health care programs, including private plans, Medicaid, or the Children's Health Insurance Program. You will also be able to find out if you are eligible for lower costs on your monthly premiums and/or lower out-of-pocket costs. If the Marketplace determines that you are eligible, you will be able to compare health plans and select the plan that meets the needs of your family and your budget. You will find out if you are eligible for these lower costs at the time you fill out the application.

It is our understanding that if you are eligible for Medicaid (sometimes referred to as Public Aid, medical assistance or medical card), or the Children’s Health Insurance Program (sometimes referred to as the All Kids Share or Premium programs), you will be enrolled automatically and may not have to wait until January 1, 2014 for Medicaid coverage to take effect. You cannot be enrolled in ICHIP and Medicaid at the same time. Your ICHIP will be terminated as of the date that your Medicaid coverage becomes effective and any claims that may have been paid by ICHIP for services incurred after Medicaid takes effect will be recovered by ICHIP. It is our understanding that as you proceed through the Marketplace on-line application process, if it appears that you will meet Medicaid eligibility, you will be asked if you would like help paying for medical bills from the last 3 months. If you answer “yes”, your Medicaid coverage may be backdated. If this happens, you will lose your ICHIP coverage as of the date that Medicaid coverage was available. This is especially important if you used providers that do not accept Medicaid or obtained prescription drugs that do not meet Medicaid requirements, since you will have to refund ICHIP for any claims paid by us for those services.
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Q16.          How much documentation will I need to provide or how difficult will it be to obtain any documentation that is requested during the enrollment process? Will I have to answer health questions?

Response:  Our review of draft versions of the Health Insurance Marketplace applications appears to indicate that the Health Insurance Marketplace application asks for basic information about you and your family, including names, addresses, and citizenship.  The application also asks for employment, health insurance, and income information only if you are seeking assistance with the cost.

If you are seeking assistance with paying your monthly premiums or your out-of-pocket costs, the amount of financial help you may get or the type of program that you qualify for depends on certain income and dependent information.

When health coverage is available through employment, you may have to ask your employer to provide certain information.

Our understanding is that if you apply using the Health Insurance Marketplace, some of the questions that you answer may be verified through various governmental resources. For example, records from the federal Social Security Administration or the Department of Homeland Security may be used to verify your citizenship or non-citizenship status. If the information you provide does not match government records, you may have to send proof of the information you provide.
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Q17.          Can coverage be denied or delayed based on my pre-existing condition(s)?  Can I be charged a higher premium based on my pre-existing condition(s)?

Response:   The good news is that you cannot be turned down for coverage because of an existing medical or health condition. Coverage cannot be delayed (sometimes referred to as a “waiting period”) because of a pre-existing condition. The rates that you will be charged for coverage will be the same as that which is charged to everyone else who is your same age and who lives in the same geographic rating area as you. Insurers cannot charge more based on consumer’s health status, claims experience, gender or profession. The only exception to this rule is that insurance companies are allowed to charge more if you use tobacco.

Rates can be based on your age and where you live. In Illinois, there will be 13 rating areas, based on the county in which you live. Refer to the website www.healthcare.gov on or after October 1, 2013 to determine the rate area applicable in your county. In addition to HealthCare.gov people can use www.GetCoveredIllinois.gov. GetCoveredIllinois.gov includes a screening tool that asks users several simple questions about their income and family size and then directs them either to the Marketplace or to ABE (ABE.Illinois.gov) – the state’s new online application system where consumers can apply directly for Medicaid, nutrition and income assistance. The toll-free number for the Help Desk is 866-311-1119.

If a person goes to www.Healthcare.gov first and appears to be eligible for Medicaid, based on their responses to financial questions, it will refer them back to ABE.

The earliest that coverage can start is January 1, 2014 (unless you are determined to be eligible for Medicaid or other government programs such as, but not limited to, the Children’s Health Insurance Program). Coverage will always begin on the first of the month. There are certain rules that will be used to determine your effective date of coverage:

If you apply/submit your completed application and any documentation that the Marketplace may request and choose your company and plan:

Your coverage will become effective on:

Between the first and 15th of the month

The first of the month following the month of your complete application

Between the 16th and the end of the month

The first of the 2nd month following submission of your complete application


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Q18.          What coverage options will I have?

Response: Coverage in the Marketplace will be sold based on its “metal level” equivalency. Generally speaking, the following metal levels will be sold:

Level:

*Description of coverage:  On average,

The premium cost will be:

Bronze

Your plan pays 60%. You pay 40%.

Lower than any other metal level

Silver

Your plan pays 70%. You pay 30%.

Higher than a Bronze level, but lower than a Gold or Platinum level

Gold

Your plan pays 80%. You pay 20%

Higher than a Bronze or Silver level, but lower than a Platinum level

Platinum

Your plan pays 90%. You pay 10%.

Higher than any other metal level

*The reference to the amount that the plan pays and the amount that you pay is not a reference to coinsurance levels.   Instead these cost-sharing figures are approximate, and apply to cost sharing to the plan as a whole. Your costs for individual services will vary.

Although premium tax credits are available for any type of plan if purchased through the Marketplace to those who qualify, it is our understanding that cost-sharing subsidies that may be able to be used to reduce out-of-pocket costs are only available on silver plans. It is not known whether all metal levels will be available in your area. You should be able to check the Marketplace on or after October 1, 2013 to determine which metal level plans will be offered in your area.
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Q19.          Will the new coverage available under the ACA be portable? I am considering moving out of state in the near future and wonder if I can take the new coverage with me when I move.

Response: The Marketplace website at www.healthcare.gov states that "No matter what state you live in, you'll be able to use the Marketplace to apply for coverage, compare your options, and enroll."

The Marketplace recommends that you apply to enroll in the Marketplace of the state that you claim as your primary residence. If you live in more than one state in a calendar year, but do not permanently move, the Marketplace recommends that you enroll in a health insurance plan that is called a “multi-state” plan. These multi-state plans will offer the same health coverage and financial help as a single state plan. However, this coverage will allow you to receive care in the state where you need it. Check the multi-state plan you select to make sure that it has provider networks in the states where you will need coverage. We do not currently have any information as to which insurance companies might offer these multi-state plans. You should be able to check after October 1, 2013 to see which companies are offering these plans.

If you purchase coverage that only provides benefits in Illinois and you move, you should contact the Marketplace to apply for health coverage within 60 days.
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Q20.          What are the benefit and services that will be covered?   Will the following services be covered: office visits, hospitalizations and/or ER visits, prescription drugs, brand-name prescriptions, MS prescriptions, transplants, acupuncture, chiropractic care, physical therapy and/or rehab, routine care, flu shots and other vaccines, mammograms, mastectomy products, diabetic supplies, mental health benefits, alternative medicine, "experimental therapies”, -ostomy supplies, orthotics, lab work and other tests, dental and vision care, hearing loss benefits?

Response:   The Health Insurance Marketplace website at www.healthcare.gov states that the benefits will include doctor's visits, hospital stays, preventive services, prescription drugs, mental health, and other categories of coverage. Plans will not be able to charge you more or refuse to cover you if you have a pre-existing condition. Specific plans and prices will be available on October 1, 2013, when Marketplace open enrollment begins. It is our understanding that there are 10 “essential health benefits” included in plans that will be available in the marketplace. These are:

1.       Outpatient care

2.       Emergency room services

3.       Treatment in the hospital for inpatient care

4.       Care before and after your baby is born

5.       Mental health and substance use disorder services: This includes behavioral health treatment, counseling, and psychotherapy

6.       Prescription drugs

7.       Services and devices to help you recover if you are injured, or have a disability or chronic condition. This includes physical and occupational therapy, speech-language pathology, psychiatric rehabilitation, and more.

8.       Lab tests

9.       Preventive services including counseling, screenings, and vaccines to keep you healthy and care for managing a chronic disease.

10.   Pediatric services: This includes dental care and vision care for kids

You can contact the Health Insurance Marketplace at 1-800-318-2596 or visit their website at www.healthcare.gov. This is a resource that will help you search for an insurance plan that meets the minimum benefits required by law. It will help you comparison shop for plans provided by various companies. In addition to HealthCare.gov people can use www.GetCoveredIllinois.gov. GetCoveredIllinois.gov includes a screening tool that asks users several simple questions about their income and family size and then directs them either to the Marketplace or to ABE (ABE.Illinois.gov) – the state’s new online application system where consumers can apply directly for Medicaid, nutrition and income assistance. The toll-free number for the Help Desk is 866-311-1119.

If a person goes to www.Healthcare.gov first and appears to be eligible for Medicaid, based on their responses to financial questions, it will refer them back to ABE.

You will need to carefully review the insurance options that will become available in the new year. Available options will not be known until the Marketplace opens on October 1st. We encourage you to make a list of all of your providers, all of the medications that you are on and any questions you may have before you begin comparing plans. You may wish to seek the assistance of a licensed insurance producer (a person who is licensed by the state to sell insurance policies) to assist you with this comparison.
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Q21.          My doctor is recommending surgery. Should I put off having the procedure done until I can transition over to new coverage?

Response: We would never give advice as to whether you should delay having a procedure done. We recommend that you discuss this issue with your doctor.
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Q22.          Is there a chance that information/choices/rates will change between the time the Marketplace first opens and the time coverage takes effect? Are insurance companies locked into what is offered and the price that will be charged until next open enrollment? Or, can the options/prices change in 2014?

Response: We do not have any information at this time.  The premium amounts will be announced on HealthCare.gov when open enrollment begins on October 1, 2013. The Marketplace has indicated that this information has not yet been released.
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Q23.          Is this new coverage in the Marketplace a governmental program like Medicare or Medicaid?

Response:  Private insurance companies offer health insurance through the Health Insurance Marketplace. These health insurance plans must meet government standards and be approved.
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Q24.          What coverage choices will I have? Can I keep the same network of medical providers? What coverage limitations will there be? What deductible options will be offered? Will I be able to choose coverage with a lower (or higher) deductible in subsequent years? Will descriptions of the plans be clear and easy to understand? How many plans will I be able to choose from? Will the coverage require extensive pre-approval of care, similar to an HMO or managed care organization? Will insurance companies be required to have a maximum out-of-pocket for coverage in 2014? What is the maximum yearly and/or lifetime coverage amount and is it subject to change? Will I have coverage if I am out of the state or out of the country, even though I remain an Illinois resident? Will providers have to accept the reimbursement rate offered by the insurance company? Will they be able to refuse me as their patient?

Response: You can contact the Health Insurance Marketplace at 1-800-318-2596 or visit their website at www.healthcare.gov for information. This is a resource that will help you search for an insurance plan that meets the minimum benefits required by law. It will help you comparison shop for plans provided by various insurance companies. In addition to HealthCare.gov people can use www.GetCoveredIllinois.gov. GetCoveredIllinois.gov includes a screening tool that asks users several simple questions about their income and family size and then directs them either to the Marketplace or to ABE (ABE.Illinois.gov) – the state’s new online application system where consumers can apply directly for Medicaid, nutrition and income assistance. The toll-free number for the Help Desk is 866-311-1119.

If a person goes to www.Healthcare.gov first and appears to be eligible for Medicaid, based on their responses to financial questions, it will refer them back to ABE.

You will need to carefully review the insurance options that will become available in the new year. Available options will not be known until the Marketplace opens on October 1st. We encourage you to make a list of all of your providers, all of the medications that you are on and any questions you may have before you begin comparing plans. You may wish to seek the assistance of a licensed insurance producer (a person who is licensed by the state to sell insurance policies) to assist you with this comparison.
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Q25.          Is it true that the government will now decide whether to approve a treatment option that has been recommended by my physician? Will there be “panels” or review boards who dictate whether or what type of treatment I receive or will there be any sort of health care rationing?

Response: Insurance companies have designed the benefits based on certain parameters. Benefits will be subject to company oversight. The Illinois Department of Insurance regulates insurance companies.
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Q26.          How will I know what plan to choose? Will someone be available to help me decide or recommend the best choices of coverage for me to choose from?

Response: Licensed insurance producers (a person who is licensed by the state to sell insurance policies) may be able to assist you with making the final decision.  Other people, known as “navigators”, “assisters” and “certified application counselors” are available to help you with the process, but will be prohibited from actually making a recommendation as to which plan you should choose.
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Q27 I will be out of the country during open enrollment. How can I enroll?

Response: The easiest way to enroll, whether you are out of the country or not, is on-line. Go to www.healthcare.gov. You will be able to apply for Marketplace (ACA) coverage three ways: online, by mail, or in-person with the help of a Navigator or other qualified helper. Telephone help and online chat are available 24/7 to help you complete your application. The paper application is not available for download. You will have to call the toll-free number and ask that an application be mailed to you.

In addition to HealthCare.gov people can use www.GetCoveredIllinois.gov. GetCoveredIllinois.gov includes a screening tool that asks users several simple questions about their income and family size and then directs them either to the Marketplace or to ABE (ABE.Illinois.gov) – the state’s new online application system where consumers can apply directly for Medicaid, nutrition and income assistance. The toll-free number for the Help Desk is 866-311-1119.

If a person goes to www.Healthcare.gov first and appears to be eligible for Medicaid, based on their responses to financial questions, it will refer them back to ABE.
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Q28.          I will have a life event in 2014 that will change my insurance needs (for example, change in marital or dependent status, becoming eligible for Medicare or losing employer insurance coverage). Will I be able to make a change in coverage due to this life event after open enrollment ends on March 31, 2014?

Response: Our understanding is that there will be special enrollment periods when life events occur. We believe these special enrollment periods will be for a period of 60 days after the event.

Once you are eligible for Medicare, you should be able to drop marketplace coverage and obtain other Medicare-appropriate coverage. The Senior Health Insurance Program (SHIP), through the Illinois Department on Aging, provides information and counseling about Medicare and Medicare Supplement policies to Medicare eligible persons regardless of age. You may contact them at 800-548-9034 or visit their website at to find a counselor in your area at: www.state.il.us/aging/SHIP/SiteSponsorListbyCountyAll.pdf
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Q29.          What if I do not have access to a computer or the internet? What if the internet traffic is so heavy that servers are not able to handle the load? Do I have to apply on-line for the Marketplace? Can I contact an insurance company or my insurance producer directly without using the Health Insurance Marketplace? Will information be mailed to me, instead? Would the cost of coverage be cheaper if I bought it on the internet?

Response: You will be able to apply for Marketplace (ACA) coverage three ways: online, by mail, or in-person with the help of a Navigator or other qualified helper. Telephone help and online chat are available 24/7 to help you complete your application. The paper application is not available for download. You will have to call the toll-free number and ask that an application be mailed to you.

Internet use may be very high on or immediately after October 1, 2013. You have until December 15th to complete the application /enrollment process for January 1st coverage. If you want to apply via internet, you may want to wait until mid to late October. Do not wait until December if you are hoping for a January 1st effective date.

You do not have to apply through the Marketplace. You can contact your insurance producer (a person who is licensed by the state to sell insurance policies) or insurance company directly. You will not be eligible for any cost assistance unless you use the Marketplace.

We do not know whether the cost of coverage will vary based on the method in which you made application. It is our understanding that Insurers cannot charge more based on consumer’s health status, claims experience, gender or profession.
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Q30.          Who do I contact to begin enrollment? Will customer service be available? How easy will it be to speak to a live person?

Response: You will be able to apply for Marketplace (ACA) coverage three ways: online, by mail, or in-person with the help of a Navigator or other qualified helper. The paper application is not available for download. You will have to call the toll-free number and ask that an application be mailed to you.

We recommend that you begin by visiting the Marketplace website at www.healthcare.gov. They have a live chat feature that is available 24/7. They also have a toll-free phone number available at 800-318-2596. TTY users should call 855-889-4325. In addition to HealthCare.gov people can use www.GetCoveredIllinois.gov. GetCoveredIllinois.gov includes a screening tool that asks users several simple questions about their income and family size and then directs them either to the Marketplace or to ABE (ABE.Illinois.gov) – the state’s new online application system where consumers can apply directly for Medicaid, nutrition and income assistance. The toll-free number for the Help Desk is 866-311-1119.

If a person goes to www.Healthcare.gov first and appears to be eligible for Medicaid, based on their responses to financial questions, it will refer them back to ABE.

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Q31.          I thought the ACA was overturned by the Supreme Court?

Response:  On June 28th, 2012, the U.S. Supreme Court upheld the constitutionality of the Affordable Care Act. In the same decision, the court ruled that states could decide not to expand their Medicaid program. It is our understanding that Illinois has elected to expand Medicaid. This means that certain individuals who did not qualify for Medicaid before may now be eligible. You cannot be enrolled in ICHIP and Medicaid (sometimes referred to as Public Aid, medical assistance or medical card), or the Children’s Health Insurance Program (sometimes referred to as the All Kids Share or Premium programs) at the same time. Your ICHIP will be terminated as of the date that your Medicaid coverage becomes effective and any claims that may have been paid by ICHIP for services incurred after Medicaid takes effect will be recovered by ICHIP. It is our understanding that as you proceed through the Marketplace application process on-line, if it appears that you will meet Medicaid eligibility, you will be asked if you would like help paying for medical bills from the last 3 months. If you answer “yes”, your Medicaid coverage could be backdated. If this happens, you will lose your ICHIP coverage as of the date that Medicaid coverage was available. This is especially important if you used providers that do not accept Medicaid or obtained prescription drugs that do not meet Medicaid requirements, since you will have to refund ICHIP for any claims paid by us for those services.
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Q32.          How secure will the information be that I provide? How will I know if someone contacts me whether or not they are trying to defraud or scam? Will my information remain confidential? What guarantee do we have that the people looking at our information are trustworthy?

Response: Our understanding is that the Centers for Medicare and Medicaid Services (CMS), part of the U.S. Department of Health and Human Services, reports that the federal data system for “health exchanges” (the Marketplace) has now been tested and certified as secure. Nevertheless, you should always be cautious and protect yourself from fraud. Never give your personal or financial information to anyone who calls or comes to your home uninvited, even if they say they’re from the Marketplace. There have been recent warnings that there may be fake, look-alike exchange / Marketplace sites. The correct website for Marketplace activity is www.healthcare.gov. The toll-free number is 800-318-2596. TTY users should call 855-889-4325. In addition to HealthCare.gov people can use www.GetCoveredIllinois.gov. GetCoveredIllinois.gov includes a screening tool that asks users several simple questions about their income and family size and then directs them either to the Marketplace or to ABE (ABE.Illinois.gov) – the state’s new online application system where consumers can apply directly for Medicaid, nutrition and income assistance. The toll-free number for the Help Desk is 866-311-1119.

If a person goes to www.Healthcare.gov first and appears to be eligible for Medicaid, based on their responses to financial questions, it will refer them back to ABE.

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Q33.          How knowledgeable will the “navigators” and “in-person assisters” be of the new provisions?

Response: It is our understanding that these individuals will receive training from both federal and state resources to assist you with the application process. These individuals will have to successfully complete training and will be certified by the Illinois Department of Insurance. These individuals will be prohibited from actually making a recommendation as to which plan you should choose. Consider contacting a licensed insurance producer (a person who is licensed by the state to sell insurance policies) for assistance in choosing a plan.
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Q34.          What protections will I have that the premium rates will not increase dramatically the year following implementation (2015)?   How frequently will insurance companies be able to change/increase the rates?

Response: It is our understanding that the health care law provides two new ways to hold insurance companies accountable and help keep your costs down. (1) Rate Review requires insurance companies to provide information regarding any rate increase of 10% or more before raising your premium. (2) the medical loss ratio requirement, sometimes referred to as the “80/20 Rule”, generally requires insurance companies to spend at least 80% of the money they take in on premiums on your health care and quality improvement activities instead of administrative, overhead, and marketing costs. We do not have any information about the frequency in which companies can adjust rates. You may qualify for premium tax credits and cost-sharing reduction subsidies that are available only through the Marketplace.
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Q35.          Will the number of people able to enroll in these new plans be limited?

Response: We currently do not have any information as to whether there will be enrollment caps in the Marketplace.
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Q36.          If I obtain coverage and am not happy with it, will I be able to change? If so, will I have to wait until the next open enrollment period?

Response:  Our understanding is that the first open enrollment period is from October 1, 2013 to March 31, 2014. After open enrollment ends on March 31, 2014, you can only get insurance through the Marketplace for 2014 if you have a qualifying life event such as a job loss, birth of a child, divorce, etc.  In those cases, you have to apply during the special enrollment period. It is unlikely that a voluntary termination of coverage would qualify for a special enrollment period; however, you should check with the Marketplace or a licensed insurance producer before dropping your insurance coverage.
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Q37.          Will family coverage be available?

Response: We presume family coverage will be available in the Marketplace. We recommend that you check on or after October 1, 2013 to determine the types of plans that will be available on and off the Marketplace and whether family coverage will be available.

Q38.          Who will be the insurance companies offering coverage in the Marketplace?

Response:  In a press release dated September 24, 2013, Governor Pat Quinn announced the names of eight insurers who will be providing state recommended plans. The names of the insurance companies that will be offering coverage through the Marketplace are:

·         Aetna Life Insurance Company

·         Coventry Health and Life Insurance Company

·         Coventry Health Care of Illinois, Inc.

·         Health Alliance Medical Plans, Inc.

·         Health Care Service Corporation, a Mutual Legal Reserve Company (Blue Cross Blue Shield)

·         Humana Health Plan, Inc.

·         Humana Insurance Company

·         Land of Lincoln Mutual Health Insurance Company

Please check the Marketplace on or after October 1st to find out more about these plans, which counties they will be available in, and the rates that will apply.
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Q39.          Will insurance companies who are allowed to sell coverage be vetted and approved by some sort of oversight agency?

Response: The Illinois Department of Insurance has regulatory oversight. The Illinois Department of Insurance is charged with protecting the rights of Illinois citizens in their insurance transactions and monitoring the financial solvency of all regulated entities.   This includes such activities as licensing insurance companies, ensuring that only licensed insurance companies sell in the state and approving policy forms available in the state.
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Q40.          What assurances do I have that, once I am insured, the insurance company will not find a way to terminate my coverage?

Response:  You will need to carefully review the insurance options that will become available in the new year. We encourage you to ask any insurance company that you are considering this question. You may wish to seek the assistance of a licensed insurance producer (a person who is licensed by the state to sell insurance policies) to assist you with this process.
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Q41.          Will there be plans available that include maternity coverage? Can I opt out of maternity coverage since I do not plan to become pregnant?

Response:  Insurance companies are required to provide 10 “essential health benefits” in plans that will be available in the marketplace. One of these 10 essential health benefits is maternity care. It is our understanding that declining coverage will not be an option. You will need to carefully review the insurance options that will become available in the new year. We encourage you to ask any insurance company that you are considering this question. You may wish to seek the assistance of a licensed insurance producer (a person who is licensed by the state to sell insurance policies) to assist you with this process.
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III.            Questions about Medicaid

Q42.          Will I be forced into Medicaid and lose my doctor?

Response: It is our understanding that if you qualify for Medicaid (sometimes referred to as Public Aid, medical assistance or medical card), or the Children’s Health Insurance Program (sometimes referred to as the All Kids Share or Premium programs) and apply through the Marketplace, you will be enrolled in Medicaid. You should discuss this situation with your providers to determine if they accept Medicaid. We believe that if you chose to enroll in a qualified heath plan outside the Marketplace, you will not be put into Medicaid. However, you will not be eligible for any premium assistance or tax credits unless you apply through the Marketplace. You cannot be enrolled in ICHIP and Medicaid at the same time. Your ICHIP will be terminated as of the date that your Medicaid coverage becomes effective and any claims that may have been paid by ICHIP for services incurred after Medicaid takes effect will have to be recovered. It is also our understanding that as you proceed through the Marketplace application process on-line, if it appears that you will meet Medicaid eligibility, you will be asked if you would like help paying for medical bills from the last 3 months. If you answer “yes”, your Medicaid coverage could be backdated. If this happens, you will lose your ICHIP coverage as of the date that Medicaid coverage was available. This is especially important if you used providers that do not accept Medicaid or obtained prescription drugs that do not meet Medicaid requirements, since you will have to refund ICHIP for any claims paid by us for those services.
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Q43.          If coverage is based on income, will I have to change coverage if my income changes?

Response: Our best understanding is that if you qualify for Medicaid (sometimes referred to as Public Aid, medical assistance or medical card), or the Children’s Health Insurance Program (sometimes referred to as the All Kids Share or Premium programs) due to your financial and family status, that is the plan that you will be enrolled in. Should your financial status change, you may no longer qualify for Medicaid, or the amount of or your eligibility for cost assistance may change. For further assistance, you should check with the Marketplace or the Illinois Department of Healthcare and Family Services, which oversees the state Medicaid program. You can find out whether you qualify for Medicaid by visiting www.GetCoveredIllinois.gov. GetCoveredIllinois.gov includes a screening tool that asks users several simple questions about income and family size and then directs the user either to the Marketplace or to ABE (ABE.Illinois.gov) – the state’s new online application system where consumers can apply directly for Medicaid, nutrition and income assistance. The toll-free number for the Help Desk is 866-311-1119.

If a person goes to www.Healthcare.gov first and appears to be eligible for Medicaid, based on their responses to financial questions, it will refer them back to ABE.
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Q44. Who do we turn to if we have problems paying the insurance premiums?

Response: We recommend that you discuss your situation with your insurance company.  Based on your income, you may qualify for Medicaid or premium tax credits and cost-sharing reduction subsidies that are available only through the Marketplace. You can find out whether you qualify for Medicaid by visiting www.GetCoveredIllinois.gov. GetCoveredIllinois.gov includes a screening tool that asks users several simple questions about income and family size and then directs the user either to the Marketplace or to ABE (ABE.Illinois.gov) – the state’s new online application system where consumers can apply directly for Medicaid, nutrition and income assistance. The toll-free number for the Help Desk is 866-311-1119.

If a person goes to www.Healthcare.gov first and appears to be eligible for Medicaid, based on their responses to financial questions, it will refer them back to ABE.
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