INDIVIDUAL MARKET PAYMENT AND ARREARS Assistance Network Program Development

2 Overview This training will help you Understand why the 1 st 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 1 st Payment Key Point: Payment for health insurance is made the month before coverage month o After enrolling, the premium is due by the 25 th 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 status o Generally applied to oldest outstanding premium Policy without APTC o Ongoing payment deadlines and thresholds for Grace Periods are established by the Carrier o 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 Policies o Ongoing payment deadline dates and thresholds for Grace Periods are established by the Carrier o Federal Rules for cancellation of coverage for non-payment also apply o 90 days grace period prior to termination of coverage o Termination notice sent with pending termination date o Full payment keeps policy in place o Non-payment cancels coverage at termination date on notice (end of 1 st month of Grace Period) 1 st Month o Coverage must extend without change 2 nd and 3 rd Months (suspension) o Plans are not obligated to continue payments to providers Can ‘Pend’ Payment status o 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 enrollment o 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 15 th - January 15 th

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

QUESTIONS?