Hometown Health is pleased to offer individual and family health insurance policies. Below are some frequently asked questions regarding our Individual & Family products:
Q: When is payment due for Individual & Family policies? A: Payment is due the 1st of the month with a 30 day grace period.
A: Will policies auto renew each year? Q: Yes, they will be mapped to the closest plan for the next calendar year.
Q: What is the deadline to submit an application if the enrollee has a qualifying event? A: The deadline is the 15th of the prior month. Example: Subscriber is enrolling with an 8/1/2017 effective date. Qualifying event is loss of coverage. Subscriber would need to enroll and pay 1st month’s premium no later than July 15th by midnight.
Q: What are Qualifying Event(s)? A: The list of qualifying events that would allow a individual to obtain coverage outside of the open enrollment period includes:
Involuntary loss of coverage
Failure to pay premiums that result in a loss of coverage is not considered involuntary
Permanent legal guardianship of a child
Move to the Geographic Service Area
Q: When do coverage terminations need to be submitted? A: Coverage terminations need to be submitted no later than the 20th of the month prior to the effective date. For example: If coverage is to be terminated effective 8/1/2017, then the termination needs to be submitted no later than 7/20/2017.
Q: If subscriber’s coverage is terminated does that terminate the enrolled dependents?
A: Yes. It’s best to enroll the family members individually in case the subscriber decides to terminate coverage. By enrolling in separate policies member disruption of coverage is minimal.
Q: Can I enroll mid-year if I do not have a qualifying life event?
A: No. If a new enrollee does not have a Qualifying Life Event within the last 60 days they are not able to enroll until the designated open enrollment period, November 1 – December 15.
Individual & Family Plan Facts
Enrolling a New Individual and Family Plan (IFP) Member
When brokers are working with a client they need to send them the link to view the quotes and enroll from their eQuote portal. This is the only way that we will know the broker should be tied to that member.
There is also a link that is located on their IFP page too but we have to go in manually and make them the broker. This is done on a monthly basis.
Members enroll online and receive ALL communication via email. (i.e. payment due & payment reminder, problems with credit cards). No paper bills are generated
Credit card or debit card with credit feature are accepted for payment or a personal check.
When enrolling a family on separate plans they cannot share an email address to create their My Benefits Account. There must be a unique email address for each policy. Make sure this is an email that the client will check every month as this is how we correspond with the member.
When enrolling for a Qualifying Life Event the member must be enrolled and paid no later than the 15th of the month prior to their effective date. (i.e. 3/1/2018 effective date, enrollment and payment must be entered by 2/15/2018). Cannot back date enrollment (unless it’s a newborn or a subscriber that is enrolled with dependents drops coverage and dependents are enrolling with their own policy).
HMO vs PPO. (HMO only available in N. Nevada) HMO uses a provider network that requires the member to choose a Renown Health Medical Group PCP. There is a few in the Carson City area. HMO also requires the member to see their PCP for specialist care or lab work.
PPO Network does not have a National Provider directory they can use out-of-state. If member goes out of network they are subject to out-of-network rates and the out-of-network deductible and out of pocket max is separate from the in-network deductible and out of pocket max. Out of network is also subject to the member being balance billed for anything the plan doesn’t pay towards the provider’s charges. PHCS Healthy Directions is the network IFP would use outside of Nevada for an emergency or urgent care.
After the Member is sold
Brokers have access on their portal to terminate policies and add dependents
To terminate a policy it must be received by the 20th of the month prior to the effective date of the policy. (i.e. Member wants to terminate the policy as of 3/1/2018, member must log in and submit the request no later than 2/20/2018, otherwise the policy would terminate 3/31/2018).
Brokers can view from their portal if the payment has been received and if the member has setup automatic payment or manual by clicking on their client’s file in Equote and clicking on the Payment Info tab.
Members will not receive a welcome packet, only their ID card in the mail. All of their documents are available via My Benefits Coverage. Which is what they registered for when they entered a username and password during enrollment.
We require a BOR letter from the member to change their broker.
com account is where the member can update information such as credit card and address, print ID card and view claims
If a member terms before the Effective date they may receive a refund. The broker should email Enrollment to inform them of such termination so the refund is timely. It takes up to 10 business days to process a refund. The refunded amount will be placed on the credit card that was used. Email for Enrollment is firstname.lastname@example.org
If a member wants to change plans before their effective date the Broker can do this in eQuote by clicking on the member’s file and click on Status Change. There you will find categories to change plan/add spouse or dependent or terminate the coverage. If the new plan costs more the credit card on file will be charged the difference the next business day. If the plan costs less than the previously chosen plan, the difference will be applied to the next month’s premium.