Grace Periods
What is the grace period for Medicare policies?
Medicare policies have a 60-day rolling grace period.
Who do we transfer to for question regarding benefits?
Questions regarding benefits are transferred to Member Services.
What is an SSA/RRB deduction?
SSA is Social Security Administration and RRB is Railroad Retirement Board. It is an automatic deduction from either the members SSA or RRB payments that is sent to Select Health to pay the member's premium.
How do you identify a Medicare policy?
By the group number.
UT/ID/CO U1000009
NV Rx only U1000010
NV U1000011
When is the Annual Enrollment Period for Medicare?
AEP is October 15 - December 7 every year.
When does a pharmacy hold occur on the policy?
Medicare policies are not subject to pharmacy holds or claim holds.
What can we tell members who have questions about a Late Enrollment Penalty (LEP)?
Let them know that there is an option to appeal the LEP. Transfer to Medicare Enrollment for more information.
What screen shows the LIS Level and the plan the member is on?
Eligibility Inquiry
What is Medicare?
Medicare is the federal health insurance program for people who are 65 or older and certain younger people with disabilities.
When do changes made during AEP go into effect?
If received by Dec 7, changes go into effect Jan 1.
What is the effective date of a termination for a policy whose grace period expired 7/31 and when will the termination be processed?
The termination date is 7/31.
The termination will be processed on 8/1.
Who determines the Low-Income Subsidy (LIS)?
Refer the member to The Social Security Administration (SSA) to see if they meet the requirements for a subsidy.
True or False: Medicare Members are charged an NSF fee for Insufficient funds.
FALSE
What are OSB's?
OSB's are Optional Supplemental Benefits. Prior to 2023, members had a separate benefit and premium for Dental and Vision. As of 2023, those benefits are part of the medical plan.
*Exception: Plan Benefit Package PBP 013 still has separate OSB's.
Can Medicare policies be cancelled anytime?
No. Medicare policies may only be cancelled during an approved Enrollment Period.
Member is paid through March. It is now May. Their monthly premium is $60.00. How much do they need to pay and by when to avoid termination?
Member needs to pay $60.00 for April by May 31st to avoid termination.
If a member wants to appeal the Late Enrollment Penalty (LEP) and fills out the form, who reviews and determines the outcome?
C2C is the name of the company that reviews and determines the outcome of the appeal. If the member has already started an appeal, they can call C2C at 833-919-0198.
How is the SSA payment setup and when do we receive SSA payments?
Review the Medicare SSA Cutoff Deadlines table and advise the member when the change will go into effect. Advise the member if they will need to make any manual payments until it is changed. Premium Billing sends an email request to 2nd Level Medicare Accounting.
We will receive the SSA/RRB payment around the end of the month that it is due.
How do we notify a member that the policy is reaching the end of their grace period and is subject to be terminated?
Courtesy calls are made twice a month for members who are in jeopardy of terminating at the end of the month.
What is the difference between AEP and OEP?
AEP is the Annual Enrollment Period Oct 15-Dec 7 ever year. Member may enroll, change or disenroll.
OEP is the Open Enrollment Period Jan 1-Mar 31 every year. Member may only cancel their Select Health Medicare plan if switching to original Medicare (Part A&B)
If a member is in their Grace Period from 4/1-5/31 and they pay only the April balance due on 5/31, when do they have to pay May?
The payment made for April on 5/31 will reset the grace period from 5/1-6/30 to make the May payment by 6/30.
You receive a call from a member who is terminated. You have advised the member the account is no longer active and there is a balance on the account. The member asks if they can continue their coverage. What are the steps?
Offer to take the payment. Advise the payment will not reactivate the policy and they may have to wait until the next AEP for coverage.
WE CANNOT OFFER A REINSTATEMENT.
Advise Enrollment the policy termed for non payment, whether they made the payment, and they are asking for option to continue coverage.
Member's premium is $0.00 and their LEP is $20.00. The member hasn't paid June or July balance of $40. Will the policy terminate if we do not receive their $40 payment by 7/31?You receive a call from a member who is terminated. You let the member know the account is no longer active but they still owe $120 on the account. The member asks to be reinstated what are the steps?
Members with a $0 premium will not terminate if the only balance is for the LEP.
Name 3 differences between Medicare and other policies.
Grace Periods - Medicare is a rolling 60-day grace period.
No benefit holds.
No NSF Fees.
No dependents, only the primary member
No AWD/Choir tickets - We email 2nd level for refunds, etc.
We cannot offer reinstatements.
Enrollment periods.
Aside from AEP, when can members enroll or change policies?
Open Enrollment Period Jan 1- Mar 31 - Switch to another Medicare Advantage plan or drop Advantage plan and go back to Original Medicare
Special Enrollment Period - under approved circumstances
Initial Coverage Election Period - when first becoming eligible for Medicare
5-Star SEP 12/8 (this year)-11/30 (next year) - to change from a non 5-Star plan to a 5-Star plan