Alternate Initial Payment Methods
Lesson Agenda Section 1: Overview Practice Exercise Scenario 1 Practice Exercise Scenario 2 Practice Exercise Scenario 3 Course Summary 30 minutes 5 minutes 5 minutes 5 minutes 5 mins 2
Lesson Learning Objectives 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 3
Section 1 Overview Alternate Initial Payment Methods
Initial Payment Methods 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 Payments THEN and NOW Credit Card E-Check Paper Check / Money Order (NEW) Direct to Carrier (NEW) Credit Card E-Check 5
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. Initial Payment Method Customer Sends Payment Payment Must be Received and Processed On Time by the Appropriate Party 1 Pay Online via Washington Healthplanfinder 1 Deadline for Payment Confirmation screen processing: before 5 pm on 23 rd of prior month 2 Mail a Check or Money Order to Washington Healthplanfinder 2 Deadline for Payment submission in the Lock Box: before 5pm on 23 rd of prior month 3 Mail a Check Directly to the Plan Carrier 3 Deadline for carrier sending payment confirmation to WA HPF: Before 5pm on the 31 st * *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 31 st. If the carrier has not received and processed the customer s payment by this time, customer enrollment will be cancelled. 6
Customer Selects Pay Online via WA HPF Method: Pay Online via WA HPF Initial Payment Screen Status Initial Payment Screen is Active Payment Note: Only payment in full is allowed when paying directly in WA HPF Payment in Made in Full Payment is Not Completed Invoice Invoice is Marked as Paid Invoice is Marked as Active Enrollment Enrollment is Complete Enrollment is Not Complete is Available is Available 7
Customer Selects Pay Online via WA HPF but Submits Differently Method: Pay Online via WA HPF Initial Payment Screen Status Initial Payment Screen is Active Payment **Note: Confirmation from carrier is due to HPF by 23 rd at 5pm Payment Submitted Direct to Carrier** Payment Submitted as Check or Money Order Invoice Note: System updates payment method as applicable. Any scheduled payments are cancelled. Enrollment Invoice is Marked as Paid Enrollment is Complete Invoice is Marked as Paid Enrollment is Complete is Available is Available 8
Customer Selects Mail a Check or Money Order to WA HPF Method: Mail Check/Money Order to WA HPF Initial Payment Screen Status Note: Invoice is sent to customer via preferred means of communication (Mail or Email) Initial Payment Screen is Initiated or Initiated Pending Receipt of Check Payment Payment is Made in Full Payment Not Made or Partial Payment Invoice Invoice is Marked as Paid Invoice is Marked as Active Enrollment Enrollment is Complete Enrollment is Not Complete is Available is N/A 9
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 Status Note: Invoice is sent to customer via preferred means of communication (Mail or Email) Payment **Note: Confirmation from carrier is due to HPF by 23 rd at 5pm Initial Payment Screen is Initiated or Initiated Pending Receipt of Check Payment Submitted Direct to Carrier Invoice Note: System updates payment method as applicable. Invoice is Marked as Paid Enrollment Enrollment is Active is Available 10
Customer Selects Mail a Check Direct to Carrier Method: Mail a Check Direct to Carrier Initial Payment Screen Status Note: Invoice is sent to customer via preferred means of communication (Mail or Email) Initial Payment Screen is Initiated or Initiated Action Required Payment confirmation from carrier is due to HPF by the 5th of coverage month before midnight Invoice Payment is Made in Full Invoice is Marked as Paid Payment Not Made or Partial Payment Invoice is Marked as Inactive Enrollment Enrollment is Active Enrollment is Cancelled Note: Change reporting is allowed at any time except between the 23 rd and the 5 th if payment has not yet been received. is Available is N/A 11
Customer Selects Mail a Check Direct to Carrier but Submits Differently Method: Mail a Check Direct to Carrier Initial Payment Screen Status Note: Invoice is sent to customer via preferred means of communication (Mail or Email) Payment must be processed in the HPF lockbox by 5pm on the 23 rd Invoice Enrollment Note: Change reporting is allowed at any time except between the 23 rd and the 5 th if payment has not yet been received. Initial Payment Screen is Initiated or Initiated Action Required Payment Submitted as Check or Money Order Invoice is Marked as Paid Enrollment is Active is Available 12
Customer Selects Direct to Carrier Important Dates When a customer selects Direct to Carrier, an extended payment deadline (31 st of the month) is provided for the carrier to complete processing and send confirmation to WA HPF If, between the 23 rd 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: Customer enrolls and selects Direct to Carrier 12/31: Carrier receives and processes payment; notifies HPF 1/1: Beginning of 2015 coverage 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; No new invoices are generated 13
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 Link takes user to Explore Your Option Page 14
Overpayments 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. 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. 15
Refunds Refunds are not widely advertised, but are possible: 1) Upon request by the customer (case-by-case basis) with active coverage: 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. 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 16
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 31 st d) If the carrier has not processed his payment by December 23 rd, his dashboard will be locked and not change can be made until payment in full is received e) All of the above 17
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: Option A Option B 18
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. 19
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