03 Feb

Premium Billing Options

Posted at

4:44pm

in

ACA News Update

Dear Vensure Client:

With your ESC Open Enrollment period currently happening or just around the corner, we would like to take this opportunity to explain the billing method for you and the employees (EEs). As you read the varying points offered under each plan, we hope that you will better understand your payment options.

PREMIUM BILLING OPTIONS

The ESC Fixed Medical Indemnity rates are calculated to match the employer’s payroll cycle(weekly, bi-weekly, or semi-monthly). Many of you currently have EEs enrolled in the Indemnity product, so you already understand how this works. This product is separate from the MEC and MV plans, but can be coupled with either of these products.

ESC FIXED MEDICAL INDEMNITY Weekly Payroll Deduction Files (via Verisource)

  • Employer only deducts on weeks when the employee worked.
  • Pre and post-tax.
  • Missed premium model allows employees to skip deductions and not repay (claims are not paid if incurred during periods of missed deductions).
  • Employee may make direct payment to provider for missed deductions, but it is not required.
  • Weekly/Bi-Weekly/Semi-Monthly coverage, as determined by your current payroll frequency.

MINIMUM ESSENTIAL COVERAGE (MEC) Direct Pay (via Verisource)

  • Payments are accepted monthly via credit card, paycard or debit card.
  • Not available on a Section 125 plan.
  • Monthly coverage.

MINIMUM VALUE PLAN (MVP) Direct Pay

  • Payments are accepted monthly via credit card, paycard or debit card.
  • Not available on a Section 125 plan
  • Pre-determined contribution levels have been established and provided to each of you
  • Employer contributions drafted via ACH each month.
  • Credit given for any employees who do not have an authorized credit card payment.
  • Monthly coverage.

Monthly List Bill

  • Employer pays bill in full and deducts as needed from employees.
  • Pre or post tax.
  • Monthly coverage.

DIRECT PAY PROCESS FOR MEC OR MVP

  • Employee completes enrollment form.
  • Application is processed, including matching demographic data from the group eligibility file with a hire date or first paycheck date.
  • PAI mails employee a Confirmation of Coverage(COC) letter, along with ID cards.
  • Employee goes to the PAI website to submit credit card information or calls PAI call center.
  • Employee must supply information in order to access the payment form, such as credit card information and email address.
  • Forms of payment include Visa, MasterCard, debit or prepaid card, so long as there is sufficient credit/funds available.
  • Card information is not stored with PAI.
  • On the 15th of each month, PAI submits a file with MEC or MVP enrollees for processing.
  • Failed transactions (invalid cards or insufficient credit) generate an email to the employee, instructing them to contact PAI customer service to make payment arrangements
  • Employees have until the last day of the following month to make payment or the policy is cancelled and they are not eligible to re-enroll until the next annual Open Enrollment period.
  • Employer contributions on the MVP will be drafted via ACH on the 15th.
  • PAI’s premium database will combine the employee direct pay with the employer contribution to match the total cost.
  • If either the employee or employer amounts do not come in on the 15th, the records will go to an error file for PAI to reconcile.
  • Employers will receive credit on the following month for any contributions made for employees who failed to make their direct payment.
  • MEC Only: Employees wishing to start coverage immediately, but miss the 15th cutoff for their first direct payment, can call PAI customer service to have a one-time payment taken over the phone.
  • Direct pay does not include individual employee payments by personal check.Coupon books are not an option for the MEC or MVP.

UPCOMING TOPICS

  • How PCORI/TRF fees are billed.
  • TRAX ACA compliance software for employers.

CONTACTS

  • Ryan Scott – ryan.scott@vensure.com
  • Anna Hoebing – anna.hoebing@vensure.com

FUN FACTS

  • A cough releases an explosive charge of air that moves at speeds up to 60mph. A sneeze can exceed speeds of 100mph. Take cover!
  • Laughing lowers levels of stress hormones and strengthens the immune system.