Alternate Initial Payment Methods

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Alternate Initial Payment

Methods

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Lesson Agenda

Section 1: Overview

30 minutes

Practice Exercise – Scenario 1

5 minutes

Practice Exercise – Scenario 2

5 minutes

Practice Exercise – Scenario 3

5 minutes

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Upon completing this lesson, you will be able to:

 Understand the new initial payment methods available in Washington

Healthplanfinder



Understand how changes in payment methods reflect in a customer’s

account

 Understand initial payment deadlines for all new methods

Lesson Learning Objectives

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Section 1

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• Paper Check / Money Order (NEW)

• Direct to Carrier (NEW) • Credit Card

• E-Check

Customers now have more options for how to pay the Initial payment

screen– they can submit paper checks, money orders, pay by credit card,

and submit payment directly to their carrier.

Initial Payment Methods

Initial Payments THEN…

… and NOW

• Credit Card • E-Check

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Payment Deadlines Vary Slightly Depending on Initial

Payment Method

Customers are always responsible for paying in full on time, regardless of the payment method, for initial payment. If payment in full is not made by the appropriate deadline, enrollment is canceled.

Customer Sends Payment Initial Payment Method

Payment Must be Received and Processed On Time by

the Appropriate Party

Pay Online via Washington Healthplanfinder

Mail a Check or Money Order to Washington Healthplanfinder

Mail a Check Directly to the Plan Carrier

Deadline for Payment Confirmation screen processing: before 5 pm on 23rd _{of prior month}

Deadline for Payment submission in the Lock Box: before 5pm on 23rd _{of prior month}

Deadline for carrier sending payment confirmation to WA HPF: Before 5pm on the 31st_* 1 2 3 1 2 3

*Direct-to-Carrier Note: It is recommended that customers allow for enough processing time when mailing

their initial payment to the carrier. Carriers are required to submit payment verification to Healthplanfinder by the 31st. If the carrier has not received and processed the customer’s payment by this time, customer enrollment will be cancelled.

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Customer Selects “Pay Online via WA HPF”

Method: Pay Online via WA HPF Initial Payment Screen is Active Payment in Made in Full Invoice is Marked as “Paid” Enrollment is Complete Change Reporting is Available Payment is Not Completed Invoice is Marked as “Active” Enrollment is Not Complete Change Reporting is Available

Initial Payment Screen Status

Payment

Note: Only payment in full is allowed

when paying directly in WA HPF

Invoice

Enrollment

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Customer Selects “Pay Online via WA HPF” but Submits

Differently

Method: Pay Online via WA HPF Initial Payment Screen is Active Payment Submitted Direct to Carrier** Invoice is Marked as “Paid” Enrollment is Complete Change Reporting is Available Payment Submitted as Check or Money Order

Invoice is Marked as “Paid” Enrollment is Complete Change Reporting is Available

Payment

**Note: Confirmation from carrier is

due to HPF by 23rd_{at 5pm}

Invoice

Note: System updates payment

method as applicable. Any scheduled payments are cancelled.

Enrollment

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Customer Selects “Mail a Check or Money Order to WA

HPF”

Method: Mail Check/Money Order to WA HPF

Initial Payment Screen is “Initiated” or “Initiated – Pending Receipt of Check” Payment is Made in Full Invoice is Marked as “Paid” Enrollment is Complete Change Reporting is Available

Payment Not Made or Partial Payment Invoice is Marked as “Active” Enrollment is Not Complete Change Reporting is N/A

Note: Invoice is sent to customer via

preferred means of communication (Mail or Email)

Payment

Invoice

Enrollment

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Customer Selects “Mail a Check or Money Order to WA

HPF” but Submits Differently

Method: Mail Check/Money Order to WA HPF

Initial Payment Screen is “Initiated” or “Initiated – Pending Receipt of Check”

Payment Submitted Direct to Carrier Invoice is Marked as Paid Enrollment is Active Change Reporting is Available Invoice

Note: System updates payment

method as applicable.

Payment

**Note: Confirmation from carrier is

due to HPF by 23rd_{at 5pm}

Enrollment

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Customer Selects “Mail a Check Direct to Carrier”

Method: Mail a Check Direct to Carrier

Initial Payment Screen is “Initiated” or “Initiated– Action Required”

Payment is Made in Full Invoice is Marked as Paid Enrollment is Active Change Reporting is Available

Payment Not Made or Partial Payment Invoice is Marked as Inactive Enrollment is Cancelled Change Reporting is N/A

Payment confirmation from carrier is due to HPF by the 5th

of coverage month before

midnight Invoice

Enrollment

Change Reporting

Note: Change reporting is allowed at

any time except between the 23rd_and

the 5th_{if payment has not yet been}

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Customer Selects “Mail a Check Direct to Carrier” but

Submits Differently

Method: Mail a Check Direct to Carrier

Initial Payment Screen is “Initiated” or “Initiated– Action Required”

Payment Submitted as Check or Money Order

Invoice is Marked as Paid Enrollment is Active Change Reporting is Available Invoice

Payment must be processed in the HPF lockbox by 5pm on the 23rd

Enrollment

Change Reporting

Note: Change reporting is allowed at

any time except between the 23rd_and

the 5th_{if payment has not yet been}

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Customer Selects “Direct to Carrier” – Important Dates

1/1: Beginning of 2015 coverage 12/31: Carrier receives and processes payment; notifies HPF 12/15: Customer

enrolls and selects “Direct to Carrier”

• When a customer selects “Direct to Carrier,” an extended payment deadline (31st _{of the month) is} provided for the carrier to complete processing and send confirmation to WA HPF

• If, between the 23rd _{and the 31st}th_{of the month prior to scheduled coverage, the carrier has not} processed payment, the customer’s account will have reduced functionality

• Full functionality will not be regained until payment in full is made

Sample Timeline:

12/15/14 12/23/14

12/31/14

1/1/15

12/23/14-12/31/14: Until payment is received…

Read-only dashboard; No option to pay online;

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Three New Statuses are Introduced to the Dashboard

Enrollment Statuses

Displayed When: “Initiated – Action

Required”

“Initiated – Pending Confirmation”

“Initiated – Pending Receipt of Check”

Application Status Submitted Submitted Submitted

Eligibility Status Conditional Approved Approved

Enrollment Status Initiated Initiated Initiated

Payment Method - Money order/paper check

- Direct to carrier

- Direct to carrier - Money order/paper check

Invoice Status Due Due Due

Navigation - Open enrollment:

Link takes user to Explore Your Option Page - Not open enrollment: Link takes user to document upload screen

Link takes user to Explore Your Option Page

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Initial Payments do allow for overpayment, and there are scenarios where

mixed payment may occur. However, unlike recurring payments, if an

overpayment is made during initial payment, the resulting credit from the

overage will not be applied to the account until payment is due for the

third month of coverage.

Overpayments

Scenario 1

Scenario 2

Suzie Q overpaid her December invoice by $10. The $10 credit will not appear until the February invoice, because at the time of payment the January invoice has already been generated.

John Doe reports a change on 11/15 and 11/23. This makes him eligible for a Special Enrollment Period for December 2014

coverage, and he is in open enrollment and can select a plan for 2015. The Dec 2014 and 2015 invoices are generated at the same time. John opts to mail in paper checks to WA HPF however, they are received and processed out of order. Therefore, any accidental “overpayment” will be credited toward the next invoice.

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Refunds are not widely advertised, but are possible:

1) Upon request by the customer (case-by-case basis) with active

coverage:

2) If coverage is cancelled while a credit exists and no future active

coverage exists, the balance will be refunded

3) Any refunds will occur on what would have been the first day of

coverage for the next month

Refunds

Scenario 1: Customer will receive a paper check

refund from WA HBE if they initially paid by e-check.

Scenario 2: Customer will receive a paper check

refund from their carrier if they initially paid the carrier the overage and HBE has written acknowledgement from the carrier that this is a fact.

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Practice Exercise – Scenario 1

Scenario:

It is Open Enrollment Year 2, and hip-hop artist Macklemore is signing up for

January 2015 coverage on Washington Healthplanfinder. After selecting a plan, he thinks about choosing the “Direct to Carrier” payment submission method. What are some important details he should be aware of when doing this?

Select all answers that apply:

a) He must mail his check directly to his plan carrier

b) He should mail his check early so that his carrier has ample time to process it

c) The carrier must receive and process the payment AND alert HPF that the amount is paid in full by the deadline of December 31st

d) If the carrier has not processed his payment by December 23rd_{, his dashboard will be}

locked and not change can be made until payment in full is received e) All of the above

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Practice Exercise – Scenario 2

Scenario:

Jennifer Lopez is calling in to the Customer Support Center. She sees the status

“Initiated – Action Required” on her dashboard, but doesn’t know what it means. She has a lot of questions for the Customer Support Representative about her coverage. Based on the

“Initiated – Action Required” status, what does the CSR already know?

Select the information that the CSR will immediately know:

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Practice Exercise – Scenario 3

Scenario:

Marshawn Lynch, a running back for the Seahawks, just finished signing up for

insurance through Washington Healthplanfinder. Three days after paying online and before his coverage becomes active, he finds out he is eligible for Seahawks insurance. He wants to cancel his enrollment and requests a refund via the Customer Support Center.

True or False:

Assuming Marshawn does not have any future coverage in the system after

his disenrollment, he will receive a check in the mail for the balance on his account from either Washington Healthplanfinder or the plan carrier.

Answer: False

Explanation:

Marshawn’s refund will be given via the same method as his original payment.

Since he originally paid online via Washington Healthplanfinder, his refund will be provided electronically as well. Had Marshawn mailed a check to his carrier, then the carrier would have been notified to cut him a new check for the refund.

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