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Individual Market payment and Arrears. Assistance Network Program Development . Overview. This training will help you Understand why the 1 st payment is critical Understand how to set expectations for continuing payment

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individual market payment and arrears
Individual Market payment and Arrears

Assistance Network Program Development


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
effectuating coverage
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
making the 1 st payment
Making the 1st Payment

Key Point: Payment for health insurance is made the month before coverage month

  • 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
methods for payment
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
late payments arrears or grace period
Late Payments (Arrears or Grace Period )
  • Partial Payments can lead to past due status
    • Generally applied to oldest outstanding premium
  • Policy without APTC
    • Ongoing payment deadlines and thresholds for Grace Periods are established by the Carrier
    • Must allow at least 30 Day Grace Period
      • Carrier notifies customer of pending termination date
    • If full payment is not made, policy is cancelled on termination date
aptc supported policies
APTC Supported Policies
  • APTC supported Policies
    • Ongoing payment deadline dates and thresholds for Grace Periods are established by the Carrier
    • Federal Rules for cancellation of coverage for non-payment also apply
    • 90 days grace period prior to termination of coverage
    • Termination notice sent with pending termination date
    • Full payment keeps policy in place
    • Non-payment cancels coverage at termination date on notice (end of 1st month of Grace Period)
  • 1st Month
    • Coverage must extend without change
  • 2ndand 3rdMonths (suspension)
    • Plans are not obligated to continue payments to providers
      • Can ‘Pend’ Payment status
    • Providers are not obligated to provide services to customers under contract with Carrier
options after cancellation
Options after Cancellation
  • Cancellation for Non-Payment itself does not create a Special Enrollment Period for a new Marketplace enrollment
    • 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
    • November 15th- January 15th
end of appointment preparation
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
where to find carrier contact information
Where to Find Carrier Contact Information