1. On-Exchange
SLP Refresher Course
Binder/Monthly Premium Payments
Grace Periods: APTC vs. Non-APTC
Suspended Accounts (CA only)
Past Due, Dunning, and Termination Notices
Refunds for Terminated Members
K. Stropich – July 2016

2. Binder vs. Monthly Premium Payments
What’s the difference?
 BINDER
 The initial premium payment a
person must make to activate their
health insurance plan.
 MONTHLY PREMIUM
 The amount the member must pay
for their selected health care plan
each month to keep their account in
good standing.

3. Binder Payments
How can a person make a
binder payment?
 Mail
 Kaiser Foundation Health Plan
P.O. Box xxxx
City of Industry, CA 91716-0508
 By phone – talk to an SLP trained CSR
 844-524-xxxx
 Check the bubbles to see the status of the application if
the ILB has not yet been issued in SLP
 Conduct a Basic Search for the member by SSN (no
dashes necessary) to pull their account and make a
payment in SLP
 Online
 Direct the member to www.kp.org/
 The member will set up an initial account and will
be able to make a payment online via the SLP
Member Portal.
• Depending on when a person initially
enrolls for an On-Exchange plan, will
determine when their binder
payment is due.
• SLP Wiki: Reference Doc:
Binder Payments in SLP – Job Aid
• SLP Wiki: Reference Doc:
SLP Job Aid – Workflow Bubbles
Definitions
• SLP Wiki: Reference Doc:
2016 KP SLP Billing Calendar

4. Monthly Premium
Payments
How can a member make
their monthly premium
payments?
 Mail
 Kaiser Foundation Health Plan
P.O. Box xxxxx
City of Industry, CA 91716-0508
 Make sure to include the ILB # on the check
 By phone – talk to an SLP trained CSR
 844-524-xxxx
 Only the subscriber can make payment
 Access account by searching ILB
 Online
 Direct the member to www.kp.org or have them log in
to their kp.org account: My Costs and Coverages to
access the SLP Member Portal
 Member can make a one time payment (OTP) for
that day or schedule a payment for the future, or
set up EzPay (auto pay)
• Members are required to make
monthly premium payments to keep
their account in good standing.
• Payments are due on or before the
last day of the month to keep the
account in good standing.
• SLP Wiki: Training Doc:
SLP Training Participant Guide
• SLP Wiki: Reference Doc:
2016 KP SLP Billing Calendar

5. So what happens if the person doesn’t
make a payment by the due date?
Non-payment of BINDER PAYMENT
 The person’s selected health plan will never become active and they will not have
health insurance with the carrier.
 No insurance for you!
Non-payment of MONTHLY PREMIUM
 The member will enter into a GRACE PERIOD.

6. Grace Periods
A grace period is the period of time after a premium payment becomes past due
and before the policy is terminated.
The grace period for On-Exchange premium payments will differ between non-
subsidized (No APTC) and subsidized members (with APTC).
Grace periods DO NOT apply for binder payments or for Passive Renewal Plans
(plans that automatically renew during Open Enrollment) and are specific to the
plan the member selects.

7. Grace Periods can be different.
Members without APTC
 Have 30 or 31 days (depending on
what state the member is in) to bring
their account current.
Members WITH APTC
 Have 90 days to bring their account
current.
To bring an account current, the member must pay all back-due premiums in
addition to the next month’s premium (if that bill has already been generated in
SLP).

8. Grace Periods for Members WithOUT APTC
• A member will receive a Past Due / Dunning Notice (SLP: eDelivery) notifying them their account is now
delinquent, how much they owe and when they must make payment by.
• Refer to the 2016 SLP KP Billing Calendar for specific dates that notices are generated and available to
the member via the SLP Member Portal.
State Length of
Grace Period
Start of Grace Period Termination Effective Date
CA 30 days 1st Day After Dunning Date Last Day of the Grace Period
CO 31 days 1st Day After Dunning Date Last Day of the Grace Period
D.C. 30 days 1st Day After Invoice Due Date Last Day of the Grace Period
GA 30 days 1st Day After Invoice Due Date Last Day of the Grace Period
HI 30 days 1st Day After Invoice Due Date Last Day of the Grace Period
MD 31 days 1st Day After Invoice Due Date Last Day of the Grace Period
OR 30 days 1st Day After Invoice Due Date Last Day of the Grace Period
VA 31 days 1st Day After Invoice Due Date Last Day of the Grace Period
WA 30 days 1st Day After Invoice Due Date Last Day of the Grace Period

9. Grace Periods for Members WITH APTC
• A member will receive a Past Due / Dunning Notice (SLP: eDelivery) notifying them when their account
first became delinquent, along with follow up notices if the account continues to be delinquent. The
notice will state how much they owe and when they must make payment by.
• Refer to the 2016 SLP KP Billing Calendar for specific dates that notices are generated and available to
the member via the SLP Member Portal.
Jurisdiction Length of G.P. Start of G.P. Term. Eff.
Date
APTC End
Date
ALL
Jurisdictions
CA, CO, D.C., GA,
HI, MD, OR, VA &
WA
3 consecutive
months
1st day of the
delinquent
coverage
month
Last Day of the
1st Month of the
the 3 month
grace period
Last Day of the
1st Month of the
the 3 month
grace period
Dates listed are for the remainder of 2016, new dates will be provided when available, specific to 2017 plan information.

10. So how do Grace Periods work?
Basically, if you do not pay your monthly premium by the due date, you will enter into
your grace period.
When you’re in your grace period, you have a limited amount of time to make your
account current again before your account will be suspended (CA only) or terminated
completely.
Let’s look at an example.

11. Meet Bob.
Bob is a new Kaiser Permanente member from California and signed up for coverage
during Open Enrollment.
He decided to sign up on the Exchange because he qualifies for an Advanced Premium
Tax Credit (APTC).
Bob decided on a Gold plan that would normally cost him
$478.54 per month, however, because he qualifies for
APTC, his monthly premium responsibility will only be $100
per month.

12. Bob is thrilled to be a new KP member!
Not so fast, Bob! There’s one thing you have to take care before you become an official
KP member.
What does Bob have to do to ensure his health insurance is active?
Pay his Binder Payment!

13. Now we’re on a roll
Bob calls the MSCC to make his initial Binder Payment and things are looking great!
Bob now has an active KP
plan for 2016!

14. Keep up with those bills!
Health insurance bills come out the month before the coverage is active and must be
paid prior to the start date, similar to most cable bills.
Bob’s February premium bill was run on January 5th. He now owes $100 for his February
coverage and that payment is due on or before January 31st.
CSR Reminder: Check the 2016 Billing Calendar to
see when bills are generated!

15. Uh oh…
Bob’s water heater exploded and landed on his car parked out front!
Needless to say, he’s run into a financial hardship situation that is preventing him from
paying his February premium on time.
He misses his payment due date and his account is now considered delinquent. Bob’s
account is now in it’s Grace Period.
How long will Bob’s Grace Period last?
For member’s with APTC
90 days.

16. Remember this chart?
Since Bob missed his payment due date, his Grace Period will begin on February 1st and
last for 90 days. His account is now considered delinquent.
Bob is still a KP member with active coverage, but he is now on a time crunch to get his
account current, or else he risks having his account terminated.
Also remember, Bob is from California. California members have a special rule associated
with their Grace Periods.
Jurisdiction Length of Start of G.P. Term. Eff.
Date
APTC End
Date
ALL
Jurisdictions
CA, CO, D.C., GA,
HI, MD, OR, VA &
WA
3 consecutive
months
1st day of the
delinquent
coverage
month
Last Day of the
1st Month of
the 3 month
grace period
Last Day of the
1st Month of
the 3 month
grace period

17. California Only!
Due to certain laws passed in California, Bob is in a different situation than KP On
Exchange members in other regions.
Per California law, Bob will still have a 90 Grace Period, however, if he does not make
his account current after the first month of delinquency, his account will become
suspended.
This means if he seeks services, he will be responsible for paying at non-member rates
until his account is fully paid up.
1st Month:
coverage as usual
2nd – 3rd Month:
coverage is suspended and Bob must pay non-
member rates if he goes in for services
See CSIR Alert from 6/6/16: Changes to CA Exchange Dunning Notices

18. For Members Outside of California:
The Grace Period will continue on as normal and no account suspensions have to be
considered.
Once a member outside of California enters their Grace Period, their account will still
be considered active and they can use their benefits as usual throughout the entire
process.
The only difference is, if the member does in fact get terminated, they will most likely
be re-billed at non-member rates for services received after their termination date.

19. So here’s how things stand:
Bob is now in his Grace Period. He will stay in his Grace Period until his account is made
current by paying all past due premiums and whatever is due for the next month. He will
continue to receive bills for the next month, regardless if he pays or not.
Grace Period start: February 1st
2nd Month of Delinquency: CA Bob’s account is now suspended, he will pay non-mbr rates
Grace Period end: April 30th (or whenever Bob gets his account current prior to this date)

20. Can Bob make a partial payment?
YES!!
Bob’s trying to make his account be in good standing again, the only thing is, he can’t
pay the full amount right now.
Let’s use this example: Bob calls in on March 11th and says he wants to make a $150
payment. AWESOME!! You gladly take Bob’s payment and let him know where he stands.
His payment will be applied to the furthest back month that is unpaid. Any partial
payment amount will be applied to the next month.

21. After a partial payment is made:
A common misconception member’s have is that once they make a payment, their Grace
Period will re-start.
A Grace Period will not end until the account is paid in full.
Let Bob know he is still in his Grace Period and his account is currently
suspended.

22. As the Grace Period progresses… Bob can take
one of two paths.
Bob calls in again to make an
additional payment and bring his
account current
 Bob’s good! As soon as he pays to
make his account have a zero balance,
his Grace Period has ended and his
account is back to good standing.
 If Bob misses another payment, he will
re-enter a new Grace Period and begin
the process from scratch.
Bob neglects to call in to make
additional payment(s) prior to
4/30, the last day of his G.P.
 Sorry, Bob. The system will
automatically terminate your account
for non-payment and issue you a
refund if you made a partial payment
on your account.
 Bob will not be able to sign up for
coverage again until Open Enrollment
or if he has an SEP.

23. Path #1: Bob’s good!
Bob calls in again to make an additional
payment and bring his account current
Let’s say Bob calls back in on March 25th and says he wants to pay
his account in full.
How much will he have to pay to bring his account current?

24. Path #1: Bob’s good!
Bob calls in again to make an additional
payment and bring his account current
He would have to pay his past due balance for March ($50) AND
his current due for April ($100), so a total of $200.
After this payment processes, his account is in good standing
again!

25. Path #2: Bob’s not so good…
So when is Bob’s official termination date?
Bob’s plan will terminate on the last day of the 1st month of his
Grace Period – February 29th.
Per law, subsidized subscribers (those with APTC) are required to be sent one dunning notice
and then a termination letter prior to being terminated. CA members have not been sent
second dunning notices since July 2015.
Bob neglects to call in to make additional
payment(s) prior to 4/30, the last day of his G.P.
See SLP Wiki: KPIF On Exchange Dunning and Termination Reference

26. Path #2: Bob’s not so good…
Bob can make another partial payment, however, if he does not
make payment(s) in full, his account will begin the termination
process the day his Grace Period ends.
If Bob made payments that applied to a month within his Grace
Period, they will be refunded to him automatically by the system
once the termination fully processes. ($50 refund for March’s
partial payment)
Bob neglects to call in to make additional
payment(s) prior to 4/30, the last day of his G.P.

27. Path #2: Bob’s not so good…
Since we still show Bob with active coverage for the month of
February due to Grace Period guidelines, KP will keep that
payment.
What happens to the premium payment he made for
February?

28. Path #2: Bob’s not so good…
February Services: covered per benefits (his plan did not term
until 2/29)
March and April Services: All of the services rendered during
these months will be reprocessed at non-member rates, because
Bob does not have active coverage.
What if Bob had services done during his Grace
Period?

29. Can Bob re-enroll?
Unfortunately, due to Bob’s plan being terminated from non-payment of premiums, he
cannot immediately re-enroll with us or any other insurance company.
Bob will have to wait until Open Enrollment (coverage starting at the beginning of next
year), or if he has a Special Enrollment Period before then.
If Bob has questions, please refer to any and all of the
Past Due Notices sent to him prior to his termination
and explain the process of how the Grace Period and
Termination process works.
Remember, this process is the same no matter what
insurance company Bob goes to.

30. A couple of additional notes:
 Always check the billing calendar to see specific dates on when bills and notices are
generated for members.
 All Past Due, Dunning, or Termination notices can be found in the member’s
eDelivery page in SLP.
 Due dates from a Past Due notice supersede any other dates listed on monthly bills
that may be generated, see below.
See SLP Wiki: KPIF On Exchange Dunning and Termination Reference