Enrollment and Eligibility (ENR) FAQ
Guidance for FAQ regarding Premium Payment and Premium Payment Re-Direct
Program Area: Enrollment and Eligibility (ENR)
Question: What if an issuer has two pathways for collection of the initial premium payment? For example, an issuer has contracted with a Third Party Administrator (TPA) to collect initial premium payments for the individual market, but for the SHOP, this service is out of scope. Some issuers are planning to collect the initial premium for SHOP using a different process. How will two different processes work with premium payment redirect?
Answer: In the scenario described, the issuers would have submitted their URL for payment redirect for individual products in the Qualified Health Plan (QHP) application but left the payment redirect question for SHOP products blank. When confirming selections via the FFM, individuals who enroll in the individual market QHP will find the URL for the payment redirect process, and the SHOP employers will be informed that they will receive a bill from the issuer.
Issued by: Centers for Medicare & Medicaid Services (CMS)
Issue Date: September 09, 2013
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