On-ExchangeSLP Refresher CourseBinder/Monthly Premium PaymentsGrace Periods: APTC vs. Non-APTCSuspended Accounts (CA only)Past Due, Dunning, and Termination NoticesRefunds for Terminated Members

K. Stropich – July 2016

Binder vs. Monthly Premium PaymentsWhat’s the difference?

BINDER

The initial premium payment a person must make to activate their health insurance plan.

MONTHLY PREMIUM

The amount the member must pay for their selected health care plan each month to keep their account in good standing.

Binder Payments

How can a person make a binder payment?

Mail Kaiser Foundation Health Plan

P.O. Box xxxxCity of Industry, CA 91716-0508

By phone – talk to an SLP trained CSR 844-524-xxxx Check the bubbles to see the status of the

application if the ILB has not yet been issued in SLP

Conduct a Basic Search for the member by SSN (no dashes necessary) to pull their account and make a payment in SLP

Online Direct the member to www.kp.org/ The member will set up an initial account and

will be able to make a payment online via the SLP Member Portal.

• Depending on when a person initially enrolls for an On-Exchange plan, will determine when their binder payment is due.

• SLP Wiki: Reference Doc: Binder Payments in SLP – Job Aid

• SLP Wiki: Reference Doc: SLP Job Aid – Workflow Bubbles Definitions

• SLP Wiki: Reference Doc:2016 KP SLP Billing Calendar

Monthly Premium Payments

How can a member make their monthly premium payments?

Mail Kaiser Foundation Health Plan

P.O. Box xxxxxCity of Industry, CA 91716-0508

Make sure to include the ILB # on the check

By phone – talk to an SLP trained CSR 844-524-xxxx Only the subscriber can make payment Access account by searching ILB

Online Direct the member to www.kp.org or have them log in

to their kp.org account: My Costs and Coverages to access the SLP Member Portal

Member can make a one time payment (OTP) for that day or schedule a payment for the future, or set up EzPay (auto pay)

• Members are required to make monthly premium payments to keep their account in good standing.

• Payments are due on or before the last day of the month to keep the account in good standing.

• SLP Wiki: Training Doc: SLP Training Participant Guide

• SLP Wiki: Reference Doc:2016 KP SLP Billing Calendar

So what happens if the person doesn’t make a payment by the due date? Non-payment of BINDER PAYMENT

The person’s selected health plan will never become active and they will not have health insurance with the carrier.

No insurance for you!

Non-payment of MONTHLY PREMIUM The member will enter into a GRACE PERIOD.

Grace PeriodsA grace period is the period of time after a premium payment becomes past due and before the policy is terminated.

The grace period for On-Exchange premium payments will differ between non-subsidized (No APTC) and subsidized members (with APTC).

Grace periods DO NOT apply for binder payments or for Passive Renewal Plans (plans that automatically renew during Open Enrollment) and are specific to the plan the member selects.

Grace Periods can be different.

Members without APTC Have 30 or 31 days (depending

on what state the member is in) to bring their account current.

Members WITH APTC Have 90 days to bring their

account current.

To bring an account current, the member must pay all back-due premiums in addition to the next month’s premium (if that bill has already been generated in SLP).

Grace Periods for Members WithOUT APTC• A member will receive a Past Due / Dunning Notice (SLP: eDelivery) notifying them their

account is now delinquent, how much they owe and when they must make payment by.• Refer to the 2016 SLP KP Billing Calendar for specific dates that notices are generated and

available to the member via the SLP Member Portal.

State Length of Grace Period

Start of Grace Period Termination Effective Date

CA 30 days 1st Day After Dunning Date Last Day of the Grace Period

CO 31 days 1st Day After Dunning Date Last Day of the Grace Period

D.C. 30 days 1st Day After Invoice Due Date Last Day of the Grace Period

GA 30 days 1st Day After Invoice Due Date Last Day of the Grace Period

HI 30 days 1st Day After Invoice Due Date Last Day of the Grace Period

MD 31 days 1st Day After Invoice Due Date Last Day of the Grace Period

OR 30 days 1st Day After Invoice Due Date Last Day of the Grace Period

VA 31 days 1st Day After Invoice Due Date Last Day of the Grace Period

WA 30 days 1st Day After Invoice Due Date Last Day of the Grace Period

Grace Periods for Members WITH APTC• A member will receive a Past Due / Dunning Notice (SLP: eDelivery) notifying them when

their account first became delinquent, along with follow up notices if the account continues to be delinquent. The notice will state how much they owe and when they must make payment by.

• Refer to the 2016 SLP KP Billing Calendar for specific dates that notices are generated and available to the member via the SLP Member Portal.

Jurisdiction

Length of G.P.

Start of G.P.

Term. Eff. Date

APTC End Date

ALL JurisdictionsCA, CO, D.C., GA, HI, MD, OR, VA & WA

3 consecutive months

1st day of the delinquent coverage month

Last Day of the 1st Month of the 3 month grace period

Last Day of the 1st Month of the 3 month grace period

Dates listed are for the remainder of 2016, new dates will be provided when available, specific to 2017 plan information.

So how do Grace Periods work?Basically, if you do not pay your monthly premium by the due date, you will enter into your grace period. When you’re in your grace period, you have a limited amount of time to make your account current again before your account will be suspended (CA only) or terminated completely.

Let’s look at an example.

Meet Bob. Bob is a new Kaiser Permanente member from California and signed up for coverage during Open Enrollment.

He decided to sign up on the Exchange because he qualifies for an Advanced Premium Tax Credit (APTC).

Bob decided on a Gold plan that would normally cost him $478.54 per month, however, because he qualifies for APTC, his monthly premium responsibility will only be $100 per month.

Bob is thrilled to be a new KP member!Not so fast, Bob! There’s one thing you have to take care before you become an official KP member.

What does Bob have to do to ensure his health insurance is active?

Pay his Binder Payment!

Now we’re on a rollBob calls the MSCC to make his initial Binder Payment and things are looking great!

Bob now has an active KP plan for 2016!

Keep up with those bills!Health insurance bills come out the month before the coverage is active and must be paid prior to the start date, similar to most cable bills. Bob’s February premium bill was run on January 5th. He now owes $100 for his February coverage and that payment is due on or before January 31st.

CSR Reminder: Check the 2016 Billing Calendar to see when bills are generated!

Uh oh…Bob’s water heater exploded and landed on his car parked out front! Needless to say, he’s run into a financial hardship situation that is preventing him from paying his February premium on time.

He misses his payment due date and his account is now considered delinquent. Bob’s account is now in it’s Grace Period.

How long will Bob’s Grace Period last?

For member’s with APTC, 90 days.

Remember this chart?

Since Bob missed his payment due date, his Grace Period will begin on February 1st and last for 90 days. His account is now considered delinquent.

Bob is still a KP member with active coverage, but he is now on a time crunch to get his account current, or else he risks having his account terminated.

Also remember, Bob is from California. California members have a special rule associated with their Grace Periods.

Jurisdiction

Length of G.P.

Start of G.P.

Term. Eff. Date

APTC End Date

ALL JurisdictionsCA, CO, D.C., GA, HI, MD, OR, VA & WA

3 consecutive months

1st day of the delinquent coverage month

Last Day of the 1st Month of the 3 month grace period

Last Day of the 1st Month of the 3 month grace period

California Only! Due to certain laws passed in California, Bob is in a different situation than KP On Exchange members in other regions.

Per California law, Bob will still have a 90 Grace Period, however, if he does not make his account current after the first month of delinquency, his account will become suspended.

This means if he seeks services, he will be responsible for paying at non-member rates until his account is fully paid up.

1st Month: coverage as usual

2nd – 3rd Month: coverage is suspended and Bob must pay non-member rates if he goes in for services

See CSIR Alert from 6/6/16: Changes to CA Exchange Dunning Notices

For Members Outside of California:The Grace Period will continue on as normal and no account suspensions have to be considered.

Once a member outside of California enters their Grace Period, their account will still be considered active and they can use their benefits as usual throughout the entire process.

The only difference is, if the member does in fact get terminated, they will most likely be re-billed at non-member rates for services received after their termination date.

So here’s how things stand:Bob is now in his Grace Period. He will stay in his Grace Period until his account is made current by paying all past due premiums and whatever is due for the next month. He will continue to receive bills for the next month, regardless if he pays or not.

Grace Period start: February 1st 2nd Month of Delinquency: CA Bob’s account is now suspended, he will pay non-mbr rates

Grace Period end: April 30th (or whenever Bob gets his account current prior to this date)

Can Bob make a partial payment?YES!!Bob’s trying to make his account be in good standing again, the only thing is, he can’t pay the full amount right now. Let’s use this example: Bob calls in on March 11th and says he wants to make a $150 payment. AWESOME!! You gladly take Bob’s payment and let him know where he stands.His payment will be applied to the furthest back month that is unpaid. Any partial payment amount will be applied to the next month.

After a partial payment is made: A common misconception member’s have is that once they make a payment, their Grace Period will re-start.

A Grace Period will not end until the account is paid in full. Let Bob know he is still in his Grace Period and his account is currently suspended.

As the Grace Period progresses… Bob can take one of two paths.

Bob calls in again to make an additional payment and bring his account current

Bob’s good! As soon as he pays to make his account have a zero balance, his Grace Period has ended and his account is back to good standing.

If Bob misses another payment, he will re-enter a new Grace Period and begin the process from scratch.

Bob neglects to call in to make additional payment(s) prior to 4/30, the last day of his G.P.

Sorry, Bob. The system will automatically terminate your account for non-payment and issue you a refund if you made a partial payment on your account.

Bob will not be able to sign up for coverage again until Open Enrollment or if he has an SEP.

Path #1: Bob’s good!Bob calls in again to make an additional payment and bring his account current

Let’s say Bob calls back in on March 25th and says he wants to pay his account in full.

How much will he have to pay to bring his account current?

Path #1: Bob’s good!Bob calls in again to make an additional payment and bring his account current

He would have to pay his past due balance for March ($50) AND his current due for April ($100), so a total of $200.After this payment processes, his account is in good standing again!

Path #2: Bob’s not so good…

So when is Bob’s official termination date? Bob’s plan will terminate on the last day of the 1st month of his Grace Period – February 29th. Per law, subsidized subscribers (those with APTC) are required to be sent one dunning notice and then a termination letter prior to being terminated. CA members have not been sent second dunning notices since July 2015.

Bob neglects to call in to make additional payment(s) prior to 4/30, the last day of his G.P.

See SLP Wiki: KPIF On Exchange Dunning and Termination Reference

Path #2: Bob’s not so good…

Bob can make another partial payment, however, if he does not make payment(s) in full, his account will begin the termination process the day his Grace Period ends. If Bob made payments that applied to a month within his Grace Period, they will be refunded to him automatically by the system once the termination fully processes. ($50 refund for March’s partial payment)

Bob neglects to call in to make additional payment(s) prior to 4/30, the last day of his G.P.

Path #2: Bob’s not so good…

Since we still show Bob with active coverage for the month of February due to Grace Period guidelines, KP will keep that payment.

What happens to the premium payment he made for February?

Path #2: Bob’s not so good…

February Services: covered per benefits (his plan did not term until 2/29)

March and April Services: All of the services rendered during these months will be reprocessed at non-member rates, because Bob does not have active coverage.

What if Bob had services done during his Grace Period?

Can Bob re-enroll? Unfortunately, due to Bob’s plan being terminated from non-payment of premiums, he cannot immediately re-enroll with us or any other insurance company.

Bob will have to wait until Open Enrollment (coverage starting at the beginning of next year), or if he has a Special Enrollment Period before then.

If Bob has questions, please refer to any and all of the Past Due Notices sent to him prior to his termination and explain the process of how the Grace Period and Termination process works.

Remember, this process is the same no matter what insurance company Bob goes to.

A couple of additional notes:

Always check the billing calendar to see specific dates on when bills and notices are generated for members.

All Past Due, Dunning, or Termination notices can be found in the member’s eDelivery page in SLP.

Due dates from a Past Due notice supersede any other dates listed on monthly bills that may be generated, see below.

See SLP Wiki: KPIF On Exchange Dunning and Termination Reference