Individual Market News
Published October 7, 2019
We know you get a lot of questions about payment during open enrollment. Here’s some important information about when a client may need to pay a past-due premium before enrolling in a Premera Blue Cross individual plan for 2020.
Who does this apply to?
This applies to members enrolling in a 2020 Premera individual plan on the exchange—with or without a subsidy—who meet the following criteria:
- Were previously enrolled on a subsidized Premera individual plan on the exchange and
- That subsidized plan was canceled for nonpayment of premium within the last 12 months
This does not impact off-exchange members.
What action should my clients take?
If your clients meet the criteria outlined above, they must pay the last month’s premium for their previous plan in addition to the first month’s premium for their new plan in order to complete their 2020 enrollment.
Example of when your client is required to pay a past-due premium:
Your client was on a subsidized Premera individual plan that was canceled for nonpayment on April 30, 2019. They want to enroll in a Premera plan on the exchange—with or without a subsidy—for a January 1, 2020 start date. In this scenario, since their plan was canceled for nonpayment within the past 12 months, they must pay the last month’s premium on the previous plan. They must also pay the first month’s premium on their new plan in order to complete their enrollment for January 1, 2020.
Example of when your client is not required to pay a past-due premium:
Your client was on a subsidized Premera individual plan that was canceled for nonpayment on November 30, 2018. In this scenario, they would not need to pay the last month’s premium to enroll in a Premera plan on the exchange for January 1, 2020, because the previous plan was canceled more than 12 months ago. They would still need to pay for the first month’s premium on their new Premera plan in order to complete their enrollment.
Action to take
If you have clients enrolling in a Premera individual plan on the exchange after being canceled for nonpayment, tell them they may be responsible for any past-due premium owed before new coverage can begin.