Individual Market payment and Arrears

1. Individual Market payment and Arrears Assistance 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 • 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 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

8. 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

9. 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

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/

12. Questions?