Payment makes health coverage official

Policies are worthless until insurance company receives premium

12/27/2013

The shadow of Health and Human Services Secretary Kathleen Sebelius is cast on a wall as she speaks at the Community Health and Social Services Center in Detroit.

ASSOCIATED PRESS

Many consumers in need of health care rushed to sign up this week so that coverage would begin Jan. 1, but they may not realize that the health-care policies are worthless until the insurance company receives the first premium payment.

Traffic was so heavy on the Healthcare.gov Web site on Monday that the Obama Administration gave consumers an extra day, extending the deadline to Tuesday for signing up for health insurance as part of the nation’s new health-care law.

“Many consumers don’t realize that their health insurance coverage will not begin until the insurance company receives that first payment,” said Brad Clark, project chief of the Neighborhood Health Association’s navigator program.

Mr. Clark, whose agency is one of two in northwest Ohio helping consumers sign up for coverage, said the Obama Administration urged the major health-insurance companies to allow extra time for those payments to come in because many consumers selected insurance plans just days before the premiums were due.

The administration requested that insurers accept payments through Jan. 10, but a check of the insurance companies providing plans to several northwest Ohio communities through the exchange showed that although most are giving consumers a grace period, a few are sticking to earlier deadlines.

“My caution to everybody is to not assume that your insurance company extended the deadline. We don’t want anyone caught by surprise,” Mr. Clark said.

Seven insurance companies offer health-insurance plans in what is known as rating area one that includes Lucas, Williams, Fulton, Defiance, Henry, and Wood counties: Anthem, Buckeye Community Health Plan, CareSource, HealthSpan, Medical Mutual of Ohio, Molina, and Paramount.

Four insurers cover rating area six that includes Ottawa, Sandusky, Erie, Seneca, Huron, and Wyandot counties: Anthem, HealthSpan, Medical Mutual of Ohio, and Paramount.

Molina officials said Dec. 24 was the deadline for payment on policies that would take effect Jan. 1. For payments received after that date the policy will be effective Feb. 1.

HealthSpan is sticking with the original deadline of Dec. 31 for premium payments, so payments must be received by that date for coverage to begin Jan. 1.

Five insurance companies, however, are moving the deadline to Jan. 10 for the first premium payment to be processed. They are Anthem, Buckeye Community Health Plan, CareSource, Medical Mutual of Ohio, and Paramount. The policies will then take effect Jan. 1, retroactively.

Mr. Clark said that he knows many consumers are confused because of the many changes and the many deadline extensions for signing up for coverage. The marketplace remains open, however, and those consumers who have not visited healthcare.gov can still shop for a plan, he said.

“The next important date becomes Jan. 14 of 2014, because for Feb. 1 coverage you have to be enrolled by Jan. 15. And then every month thereafter leading up to the March 31 deadline it’s important that you sign up before the 15th of every month,” he said.

Under the Affordable Care Act, most adult Americans under age 65 will be required to have health insurance by April 1 or face a fee of $95 or 1 percent of their annual income, which would be assessed when they file 2014 taxes.

The marketplace offers four coverage levels: platinum, gold, silver, and bronze. The platinum or gold plans generally have higher premiums but smaller co-pays and deductibles, whereas a silver or bronze plan will have lower premiums with higher co-pays and deductibles.

Those with incomes below $11,490 for an individual and $23,550 for a family of four may be eligible to enroll in Medicaid and pay no monthly premium under the state’s expanded program that was also put in place by the Affordable Care Act.

Contact Marlene Harris-Taylort Marlene Harris-Taylor at: mtaylor@theblade.com or 419-724-6091.