INDIVIDUAL MARKET UPDATE
HIGHMARK INDIVIDUAL INVOICES
Highmark invoices for individual customers reflect their plan enrollment at the time of the bill generation. Customers that are in transition at the time the invoice generates may believe they were billed for incorrect amounts. Please follow these steps to ensure customers are properly enrolled and pay the correct amounts:
- Confirm the customer enrollment has been received and processed by calling or emailing Producer Hotline
- Advise the customer that their next invoice will reconcile the charges to the correct premium amounts. Adjusted invoices cannot be generated.
- If the customer is billed an incorrect amount, they should pay the amount they owe based on their correct plan selection, not the amount of the invoice. They
can pay by phone to ensure they are paying the correct amount by calling:
- Off-exchange business: 800-544-6679
- On-exchange business: 888-510-1084
Initial invoices for 2017 were mailed to the customers' permanent home address and not the billing address indicated on the application. There is no need to contact Highmark regarding this as all future invoices will be mailed to the mailing address requested.
ON-MARKETPLACE CANCELLATIONS OR ENROLLMENT QUESTIONS
On-Marketplace customers that wish to cancel their enrollment or question changes or corrections to enrollment must do so through the Marketplace by calling 1-800-318-2596. Highmark is unable to process On-Marketplace cancels or plan changes/corrections and will refer customers back to their agent or to contact the Marketplace directly.
MARKETPLACE SPECIAL ENROLLMENT PERIOD (SEP) PILOT
CMS is launching a new pilot program in 2017 to test a process that requires pre-enrollment verification of consumers' special enrollment period (SEP) eligibility for Individual Marketplace coverage.
This pilot program on HealthCare.gov is intended to test how pre-enrollment verification affects compliance, enrollment, continuity of coverage, the risk pool, and other outcomes. It impacts all states served by the HealthCare.gov Individual Marketplace platform.
Your clients' applications may be among those randomly flagged to have their plan selections held by the Marketplace until they submit documentation to prove their SEP eligibility. Review the fact sheet below for more information and be ready to answer your clients' questions.
NEPA ID CARDS PRINTED WITH INCORRECT COPAYS
NEPA ID Cards were printed with incorrect copay amounts for the following plans:
- My Lehigh Valley Flex Blue HMO 1000G
- My Lehigh Valley Flex Blue HMO 2500S
- my Priority Blue Flex HMO 2100S
- my Priority Blue Flex HMO 6800B
- my Priority Blue Flex HMO 1000G
Please assure your customers that the 2017 ID card was printed in error. Customers should refer to their benefit booklet or SBC for the correct copay. New ID cards are in process of being mailed along with an apology letter.
Producers can access full benefit booklets and SBCs by visiting:
If you have any questions, please contact your Highmark Individual Sales Channel Consultant.
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