Becoming appointed

Chorus Community Health Plans (CCHP) partners with four General Agencies to offer you access to sell our plans. General Agencies appointed with CCHP include:

Broker Resources
(also works with out-of-state brokers)
Alayna Obluck
Phone: (414) 766-9470 Ext. 1
(800) 472-9002 Ext. 1
Email: Alayna@brokerresources.com

Cyganiak Planning
Monica Davis
Phone: (262) 783-6161
Email: mdavis@cyganiakplanning.com

Milwaukee Brokerage Employee Benefits
Lorenzo Draghicchio
Phone: (414) 961-4900
Fax: (414) 961-2411
Email: Lorenzo@milwaukeebrokerage.com

Transition Health Benefits
(also works with out-of-state brokers)
Todd Catlin
Phone: (262) 439-4560
Email: Todd@thbwi.com 

Commissions

All commissions are paid directly to the General Agent. Please start with your General Agent for any questions on commissions.

Getting started

CCHP believes in forging long-lasting relationships with our broker partners. Below you will find the steps to follow when becoming appointed to sell our CCHP products.

1. Choose a General Agent to work with from the list at left.
2. Complete our online appointment application found here: chorushealthplans.org/for-brokers/become-appointed   
3. Upload the required documents to your application.
   • Copy of your Individual Marketplace Certificate of Completion
   • Copy of your Errors & Omissions Certificate of Liability Insurance
   • Copy of your Wisconsin Health Insurance License
   • Copy of your signed Business Associate Agreement, which can be found on our website under Brokers.
4. Contact your General Agent to discuss their commission schedule, and fill out necessary payment forms.
5. Create your Broker Portal Account: Once your application is approved, you will receive an email with instructions on how to create your account and log in. 
6. Watch your email for important Welcome Training materials to acclimate yourself to our plans.

For additional questions on becoming appointed with CCHP, please reach out to Broker Support at CCHP-BrokerSupport@chorushealthplans.org.

Eligibility guidelines

Residency requirements

To be eligible for a CCHP plan, the member must be a Wisconsin resident and reside in CCHP’s service area. A permanent address must be provided. A P.O. Box will not count toward a residency address; however, it can be used as a mailing address.

Eligible dependents attending college outside of the service area may be covered by their parents’ plan as long as their parents meet the residency requirements.

Members who live or work outside of the service area for part of the plan year will be considered a Wisconsin resident if they reside in the State of Wisconsin for at least half the year and file taxes in the State of Wisconsin. 

Marketplace eligibility requirements

To enroll for coverage with a CCHP plan, the applicant must also meet the requirements for being a qualified individual under the Health Insurance Marketplace®, including, but not limited to, each of the following:

• Contract holder is a citizen or national of the United States or a noncitizen who is lawfully present in the United States.
• Contract holder is reasonably expected to be a citizen or national of the United States or a noncitizen who is lawfully present in the United States for the entire period for which enrollment is sought.
• Contract holder is not incarcerated (other than incarceration pending disposition of charges).

Social Security number requirement
Social Security numbers are required for all applicants for coverage. If any applicant is not able to provide a Social Security number at application time, a written explanation or acceptable immigration documentation should be included with that application.

Tobacco users
A tobacco surcharge is added to any tobacco users age 40 and older that are applying for coverage on a CCHP health plan. 

Dependent eligibility

CCHP recognizes an eligible dependent as the contract holder’s legal spouse, child, grandchild or the child or grandchild of the contract holder’s spouse.

The term child includes any of the following:

• A natural child
• A stepchild or a child for whom legal guardianship has been awarded to the contract holder or contract holder’s spouse
• A legally adopted child
• A child placed for adoption with the contract holder
• A child for whom health care coverage is required through a Qualified Medical Child Support Order or other court or administrative order
• The term grandchild means a child of a covered dependent child until the covered dependent who is the parent turns 18 years of age.
• A child listed above must be under age 26 at the time of enrollment.
• A child who meets the requirements set forth above ceases to be eligible as a dependent on the last day of the year in which the child turns age 26.
• A dependent will also include an unmarried child age 26 or older who meets the following criteria:
  - The child is unable to hold a self-sustaining job due to intellectual disability or physical handicap.
  - The child is chiefly dependent on the contract holder for support and maintenance.
  - The child’s incapacity existed before he or she reached age 26.
  - The contract holder’s family coverage remains in force under this contract.
• A dependent also includes an adult child who meets all of the following criteria: The child is a full-time student, regardless of age, attending an accredited vocational, technical or adult education school, or an accredited college or university; or the child was under age 27 and called to federal active duty in the National Guard or in a reserve component of the U.S. Armed Forces while attending, on a full-time basis, an institution of higher education.

Child(ren) only policies

CCHP follows the Affordable Care Act requirements to allow children under the age of 19 to enroll in a plan without a parent or guardian.

1. Getting Started

Start by logging into our Broker Portal. If this is your first time logging in, your username is the email address you provided and the password is Pass@word1.

2. Accessing your account

From the login screen, the system will navigate you to your broker landing page. From here, you have the ability to access your book of business, including submitted health and dental applications and enrolled member policies.

Or navigate to My Shortcuts to:

• Access a list of your clients by clicking on Contacts.
• Access a saved quote by clicking on My Quotes.
• Access a saved application by clicking on My Applications.
• Access your effectuated members by clicking on My Policies.

3. Quoting an Off-Exchange Plan

To obtain a quote, locate the Get Quote button located at the top of the home page. Here you will be able to quote both our Health and Dental plan options.

Select the plan type you want to get a quote for. (When selecting Health Plan, you will have the option to add a Dental Plan within the same quote, once you select Enroll).

• Fill in the required details.
  - All applicants’ gender, date of birth and tobacco usage
  - ZIP code
  - Enrolling for coverage during Open Enrollment or with a Qualifying Life Event
  - Select the effective date.

If they do not want to purchase a plan through the Exchange or do not qualify, leave the income section blank.

• Select the Get Quote button to proceed to the Plan Options page.
  - You can choose up to three plans to compare at a time.
  - You can choose to save the quote, email the quote, and download the quote and plan details to a PDF.
  - If ready to enroll, click the Enroll in This Plan button next to the desired plan.

4. Completing the client’s application

• Register an account for the client.
  - Fill in the client’s first name, last name, email address, password and security question. (For existing clients, click on the Existing Contact tab, and fill in the necessary information to look up the client’s account and start a new application.)
• Once you have created the account, you will be directed to the application. [Portions of the application will be pre-filled with the account information you just submitted.]
  - The Applicant Profile page collects the personal information of the applicant. This includes the applicant’s home address, mailing address, contact information, eligibility and current/previous health care coverage questionnaire.
  - Answer all required eligibility questions.
  - At the Additional Information page, you have the ability to upload documents,
  for example, proof of a Qualifying Life Event, and save the documents to
  the application.
  - Once the application is complete, you may e-sign on behalf of your applicant (if present) or send the application to the applicant’s email to e-sign themselves.
  - Once the application is finished, you will be provided the option to make a payment to effectuate coverage. Binder payments are required prior to the effective date and can be made at the time of application, via credit card or bank account. 
  - If a member selected a Dental Plan with their health application, you will be directed to a separate dental application after submitting the health application. 
  -- A pre-filled dental application will display after submitting the
  health application’s binder payment.
  -- A separate binder payment will be collected for any applicable
  dental application.
  - The application will only be considered complete when the e-signature has been completed and the binder payment has been made.

Enhanced Direct Enrollment
(On-Exchange Quotes and Application submission)

We are an Enhanced Direct Enrollment (EDE) platform. This means you have the ability to quote and submit Marketplace applications without a double redirect to and from the Marketplace. For more information and to enable EDE in your Broker Portal, reach out to the Broker Support team at CCHP-BrokerSupport@chorushealthplans.org.

For additional questions on obtaining a quote and navigating your Broker Portal, please contact our Broker Support team at CCHP-BrokerSupport@chorushealthplans.org.

Completing an application

To submit an application online, you can go through our online quoting system at chorushealthplans.org or on the Marketplace.

To submit a paper application, you can mail, fax or email it to:

• Mail: Chorus Community Health Plans
          P.O. Box 1997
          Milwaukee, WI 53201-1997
• Fax: (414) 266-1611
• Email: CCHP-MemberSales@chorushealthplans.org

What to include with the application
The following information must be included in an application:

• Full name of all applicants
• Full date of birth for all applicants
• Gender of all applicants
• Physical mailing address
• Email address, if available
• Social Security numbers for all applicants
• Premium payment information for the binder payment, as well as ongoing premium payments

Not-taken Policy/Right to Review Policy
Applicants enrolling for coverage shall be provided a 10‑day period from receipt of the contract to examine and return the contract and have the premium refunded. If medical services were received during the 10‑day period, and the applicant returns the contract to receive a refund of the premium paid, the applicant must pay for such services. Requests for termination of On-Exchange plans must be made at the Marketplace.

Coordination of benefits
CCHP’s contract will be coordinated with benefits under any other policy or plan that provides benefits or services for medical, pharmacy, or dental care or treatment to an eligible covered person. Any such policy or plan is called the Primary Plan. For specific coordination of benefits questions, please contact Customer Service at (844) 201‑4672.

Special Enrollment Periods

A Special Enrollment Period is defined as a time outside the Annual Open Enrollment Period when you can sign up for health insurance.

60-day Special Enrollment Period

An applicant and eligible dependents may enroll during a 60-day Special Enrollment Period. To do so, the applicant must complete and sign an application for coverage and pay any required premium during the period.

The applicant’s effective date of coverage will be determined based on the following:

• If the Special Enrollment Period is for birth, adoption, placement for adoption or placement in foster care, the effective date of coverage will typically be the date of birth, adoption, placement for adoption or placement in foster care.
• In the case of a newborn, including the newborn of a qualified dependent child, the applicant’s newborn is covered from the moment of birth, after receipt of a claim for the birth.
• If the applicant is required to pay an additional premium to provide coverage for the newborn, then the applicant must notify CCHP and pay the required premium within 60 days of birth in order to continue coverage for the newborn beyond the initial 60-day period.
• If the applicant does not notify CCHP and pay the additional premium for the newborn within 60 days of birth, the applicant may still obtain coverage for the newborn on or before his/her first birthday by completing an application and paying any past-due premium.
• If there is no additional premium for the newborn, CCHP requests that the applicant notify CCHP of the birth of the applicant’s newborn.
• If the Special Enrollment Period is for marriage or loss of minimum essential coverage, the effective date of coverage will typically be the first day of the month following the date of marriage or loss of minimum essential coverage.

If the Special Enrollment Period is for any other reason, the effective date of coverage will be determined based on when a plan is picked and is typically the 1st of the following month after a plan is picked. The Marketplace may designate an earlier effective date of coverage in certain circumstances.

Federally recognized tribe applicants

Members of federally recognized tribes and Alaska Native Claims Settlement Act (ANCSA) Corporation shareholders can enroll in coverage any time of year. There’s no limited enrollment period for these individuals, and they can change plans up to once a month.

Changes to an existing plan

Appeals and Prior Authorizations

Complaints and appeals

Members have the right to complain about services offered through Chorus Community Health Plans or the practitioners and providers in our network, or any other issue. They also have the right to file an appeal when they are unhappy with a decision that has been made by CCHP. At any time during the course of the complaint and appeal process, the member may choose to designate an authorized representative to participate in the complaint and appeal process on their behalf.

What if a member has a complaint?

The member may contact Customer Service at (844) 201-4672. Customer Service representatives are available during regular business hours, Monday through Friday. After CCHP receives their complaint, we will notify them of our decision within 30 days.

How to file an appeal

The member or the member’s authorized representative can file an appeal within 180 days of CCHP’s decision concerning any matter.

To file a formal appeal, the member or member’s authorized representative should write down their concerns and email or mail their written appeal (in any form), along with copies of any supporting documents to CCHP. The member may submit their written appeal via mail or email to:

• Mail: Chorus Community Health Plans
          P.O. Box 1997
          Milwaukee, WI 53201-1997
• Email: CCHP-Appeals@chorushealthplans.org

We will respond to the member within five business days notifying them that the appeal was received. Depending on the type of appeal, either our appeals committee or specialist will review the appeal, investigate and provide the member with a decision within 30 calendar days of receiving the appeal.

Notification will include when the resolution may be expected and why additional time is needed. The total time for resolution will be no more than 45 days from the date the appeal was received. CCHP also offers an expedited appeals procedure for appeals that require immediate action. See the plan’s Evidence of Coverage for more details.

What if the member disagrees with
the decision?

The member may try to resolve their problem by taking the steps outlined above in the complaint and appeal process. They may also contact the Office of the Commissioner of Insurance, a state agency which enforces Wisconsin’s insurance laws, and file a complaint. The member can contact the Office of the Commissioner of Insurance by writing to:

Office of the Commissioner of Insurance
Complaints Department
P.O. Box 7873
Madison, WI 53707-7873

The member can call (800) 236-8517 or email complaints@ociwi.state.us and request a complaint form.

External Review Program

When we have denied an appeal, the member may have the right to have our decision reviewed by an independent review organization external to CCHP. The member may file a written request for an external review within four months after the date of receipt of the notice of adverse benefit determination or final internal adverse benefit determination. To request an external review, they can call toll-free (888) 866-6205 to request an external review request form. Fax this form to (888) 866-6190, email the form to FERP@maximus.com, or mail to:

Maximus Federal Services
3750 Monroe Ave., Suite 705
Pittsford, NY 14534

*CCHP Dental members do not have access to the external review program.

Prior Authorization process
A Prior Authorization is a process performed to determine whether the requested treatment or service is medically necessary, that such treatment or service will be obtained in the appropriate setting, and/or will be a covered service. Please see the plan’s Evidence of Coverage for specific coverage questions or call Customer Service at (844) 201-4672.