UHC Terming for Non Payment on Jan 8th

[saintstigers]

A UHC broker services rep told me that the company will be terming all Jan 1, 2016 on-exchange policies if the first month's premium is not received by January 8th. Including those members that had a 2015 policy and renewed onto a new 2016 policy.

I thought carriers were required by law to give members 30 days to pay their first month's premium???

 

[STIBROKER]

I thought carriers were required by law to give members 30 days to pay their first month's premium???

actually its 3 months........

Under the Affordable Care Act (ACA), if a patient who receives an advance premium tax credit does not pay his or her health insurance premiums in full, he or she enters a 90-day "grace period." During the first month of the grace period, the patient continues to have health insurance coverage, and the patient's health insurer will pay claims for health care services provided to the patient during that time. However, if the patient enters the second or third month of the grace period, the health insurer may pend claims for services provided to the patient during that time.

Affordable Care Act "grace period"

 

[AllenChicago]

it looks like this is applicable to even the first month's premium if the applicant is subsidized?

 

[Tkruger]

It applies to On X plans only. Off X you have a 30 grace period.

 

[Ann H]

The 90 day grace period that is allowed for subsidized business is not applicable to the initial premium. The policy is not activated unless the first premium is paid. Technically, there is no grace period for the first premium, although most carriers are allowing it.

 

[MBSC]

What happens if I’m late with a monthly health insurance premium payment?

The answer depends on whether you are receiving advanced premium tax credits. For people receiving advanced premium tax credits, if a payment due date is missed, insurers must provide a 90-day grace period during which consumers can bring their premium payments up to date and avoid having their coverage terminated. However, the grace period only applies if an individual has paid at least one month’s premium.

People not receiving advanced premium tax credits are expected to get a much shorter grace period; currently, the general practice is 31 days but it may vary in each state.

Reference: Health Reform FAQs | The Henry J. Kaiser Family Foundation

45 CFR 156.270 - Termination of coverage for qualified individuals.
(d) Grace period for recipients of advance payments of the premium tax credit. A QHP issuer must provide a grace period of three consecutive months if an enrollee receiving advance payments of the premium tax credit has previously paid at least one full month's premium during the benefit year.

Reference: https://www.law.cornell.edu/cfr/text/45/156.270

 

[WiscBroker]

How about this one- client paid for Jan. back in November, UHC admits it see the payment, but their system shows the policy, which is new and effective 1/1, has a paid through date of 1/1. So, the client's policy is not activated, cannot access benefits, cannot get online, no cards, no nothing from UHC. She calls UHC and is told she is 'ineligible' for coverage. I call broker support and they say, 'oh there has been a pause in the system and the payment is not being applied, we need to have someone figure out why it is not being appied.'

I can totally see this policy getting termed for nonpayment on Jan 8 even though the client has indeed paid and the insurance company says they see the payment but for some stupid reason doesn't know how to apply the payment.

 

[saintstigers]

How about this one- client paid for Jan. back in November, UHC admits it see the payment, but their system shows the policy, which is new and effective 1/1, has a paid through date of 1/1. So, the client's policy is not activated, cannot access benefits, cannot get online, no cards, no nothing from UHC. She calls UHC and is told she is 'ineligible' for coverage. I call broker support and they say, 'oh there has been a pause in the system and the payment is not being applied, we need to have someone figure out why it is not being appied.'

I can totally see this policy getting termed for nonpayment on Jan 8 even though the client has indeed paid and the insurance company says they see the payment but for some stupid reason doesn't know how to apply the payment.

UHC is totally screwy with their billing and enrollment this year. Not sure if intentional or incompetence.

 

[AllenChicago]

UHC is totally screwy with their billing and enrollment this year. Not sure if intentional or incompetence.

Your key words are "this year". They didn't have these issues in 2015, which points to "intentional", vs "incompetence". Especially in light of the "We Screwed Up!" statements from United Healthcare leadership, removal of plans from UHOne.com, Reduction in Commissions, and administrative snafus that are keeping 2016 UHC applicants from becoming 2016 UHC customers.

 

[WiscBroker]

Your key words are "this year". They didn't have these issues in 2015, which points to "intentional", vs "incompetence". Especially in light of the "We Screwed Up!" statements from United Healthcare leadership, removal of plans from UHOne.com, Reduction in Commissions, and administrative snafus that are keeping 2016 UHC applicants from becoming 2016 UHC customers.

Intentional would be considered illegal, would it not? If so, will we see a class action lawsuit?