Time frame
November 1-Janurary 15
What is on exchange?
On-exchange plans are plans that you purchase through the health insurance Marketplace.
What is the Market Place?
What is the payment processing times for mailed payment?
( up to 15 days)
What is (SEP)?
If member has a Qualifying life event to enroll into coverage outside of OEP
When do members receive ID cards?
7-10 days after Binder payment has been made.
What are the different ways members can access the Market Place application?
What is the TAT for Debit/Credit card refund?
5-7 business days after review is complete
Qualifying events?
On what date can you start transferring members to Telesales for OEP questions?
Oct 25 (10/25)
If Member wants to speak with live person to enroll where do we send them?
Telesales or Marketplace
How long does mem have to add newborn to coverage?
An eligible child born to member or spouse will be covered from the time of birth until the 31st day after its birth.
Where are all NM On-exchange members directed for Premium and billing questions?
BeWellNM
bewellnm.com or 1-833-862-3935
If member is inquiring plan changes where do we direct them?
Direct member to their state marketplace, or transfer member to Telesales 800-806-0451.
When do existing members receive renewal letters/email?
10/21
Where can you find a copy of member annual plan change letter?
Doc360
What Demographic changes are reported to Market Place?
Date of birth (DOB), name, SSN, address, gender, and phone number.
When do Members fall into grace period after past due payment?
No subsidy: 1 month after due date
With subsidy: 3 months after due date
How long after loss of coverage does member qualify for SEP?
Member must have lost qualifying health coverage in the last 60 days or expects to lose coverage in the next 60 days.
What is the OEP enrollment exception for WA and NJ?
November 1- January 31
What is gated vs non gated?
Gated: A referral is required to see a specialist
Non-Gated: A referral is NOT required to see a specialist
When do we transfer member to Market Place?
Adding or removing a dependent,
Disenroll from the plan,
Plan renewal
Member Demographic Updates
Deceased member notification
How long does member have to make binder payment?
Binder must be received before the plan's start date or before the end of the month.