Individual market payment and arrears
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Individual Market payment and Arrears - PowerPoint PPT Presentation

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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