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INDIVIDUAL MARKET PAYMENT AND ARREARSAssistance Network Program Development
2
Overview
This training will help you • Understand why the 1st payment is critical• Understand how to set expectations for
continuing payment• Help customers recognize the difficulty of getting
behind in payments (Arrears)• Educate customers on avoiding cancellation for
non-payment
3
End of Enrollment Transaction
4
Effectuating Coverage
For a Policy to be Effectuated:• Electronic enrollment information goes from C4HCO to Carrier
• “834”• This can take up to 2 days
• Carrier sends customer an invoice• This may take 10 days• C4HCO recommends waiting for the invoice to make payment as each
Carrier may have different options for payment
• Customer submits the payment• Carrier sends C4HCO policy effectuation information• Carrier send customer Evidence of Coverage (Certificate of
Coverage), card, and other policy information• Customer account in C4HCO is updated with enrollment
information
5
Making the 1st Payment
Key Point: Payment for health insurance is made the month before coverage month
o After enrolling, the premium is due by the 25th of the month prior to coverage beginning
• If not made on time, the enrollment will be considered ‘cancelled’ and the customer would need to re-apply
• Open Enrollment or Special Enrollment Period needed
6
Methods for Payment
Methods of premium payment: A QHP issuer must accept as methods of payment, and present all payment method options equally for a consumer to select their preferred payment method.–At a minimum:• paper checks• cashier’s checks• money orders• EFT• all general-purpose pre-paid debit cards
7
Late Payments (Arrears or Grace Period )
• Partial Payments can lead to past due statuso Generally applied to oldest outstanding premium
• Policy without APTCo Ongoing payment deadlines and thresholds for Grace Periods are
established by the Carriero Must allow at least 30 Day Grace Period
• Carrier notifies customer of pending termination date o If full payment is not made, policy is cancelled on termination date
8
APTC Supported Policies
• APTC supported Policieso Ongoing payment deadline dates and thresholds for Grace Periods are
established by the Carriero Federal Rules for cancellation of coverage for non-payment also applyo 90 days grace period prior to termination of coverageo Termination notice sent with pending termination dateo Full payment keeps policy in placeo Non-payment cancels coverage at termination date on notice (end of 1st
month of Grace Period)
• 1st Montho Coverage must extend without change
• 2nd and 3rd Months (suspension)o Plans are not obligated to continue payments to providers
• Can ‘Pend’ Payment statuso Providers are not obligated to provide services to customers under
contract with Carrier
9
Options after Cancellation
• Cancellation for Non-Payment itself does not create a Special Enrollment Period for a new Marketplace enrollmento Other SEP may exist
• Medicaid/CHP+ applications and enrollments are available all year
• CICP enrollments continue all year• Next Open Enrollment Period for Marketplace coverage
o November 15th- January 15th
10
End of Appointment Preparation
• Print enrollment submission page• Ask customer to be aware of invoice and Carrier payment
option• Educate customer on importance of ongoing payment• Make customer aware of need to understand Grace Period,
if they encounter it
11
Where to Find Carrier Contact Information
http://grants.cohbe.org/http://connectforhealthco.com/how-it-works/enrollment-updates/http://connectforhealthco.com/how-it-works/enrollment-deadlines/
QUESTIONS?
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