Premium Payment Requirements
As a reminder, the State Health Plan operates on a pre-pay basis. That means all premiums are due by the first of every effective month. While it is not unusual for an employing unit to have some discrepancies on any given month, those discrepancies need to be reconciled by the following month. The Plan is pleased to report that the majority of employing units have no problem managing their enrollments and corresponding monthly premiums within these parameters. Unfortunately, however, a growing number of employing units have discrepancies that are older than 60 days.

Premium Delinquency
When the premium payment does not match the enrollment at Blue Cross and Blue Shield of North Carolina, it is important for groups to carefully review the overage/shortage sheets that are provided by BCBSNC to address discrepancies. It is also important to note BCBSNC's methodology for applying premium payment. The premium is applied at the member, not the group, level. For that reason, it can be misleading when you make an overpayment on one member and an underpayment on another. While the net effect of that action may be a zero balance, a discrepancy remains for each member. BCBSNC will not apply the overpayment from one member's account to the underpayment on another account. The longer the discrepancy goes uncorrected, the more difficult it becomes to identify. Over time, the amount of the credit or the delinquency can become quite large.

The key to managing the premium is to maintain current eligibility and to manage the over/shortage sheets in a timely manner. The Plan is available to assist with any ongoing issues, as they must be resolved in a timely manner. Delinquencies older than 60 days may result in a claims hold, which will impact all members on the group.

Over the next few weeks, the Plan will be reaching out to employing units with outstanding discrepancies over 60 days. To avoid a claims hold, those discrepancies must be resolved within the following 60 days.

As an additional reminder, any members identified as in arrears on the reconciliation statement, and whose balance is not brought current by the next billing cycle, will be terminated from the State Health Plan. The termination date will be one day prior to the effective date of the arrears acknowledgement.

Reminders

Enrollment Rules

• New employees - Must enroll themselves and their dependents within 30 days from their date of hire. Enrollment past 30 days is allowed, but employee/dependents over the age of 19 may be subject to a pre-existing conditions waiting period. For late enrollees, coverage will be effective the first of the month following the written request. Requests after 30 days require approval by the State Health Plan. If approved, any premium deducted from the employee's paycheck must be payroll deducted on a post tax basis.
• Adding dependents - Must occur within 30 days from a qualifying life event. Requests after 30 days require approval by the Plan.
• Employee terminations - To ensure members receive timely COBRA notifications, terminations should be processed within 30 days after the termination or reduction in hours. Requests after 60 days require approval by the Plan.
• Dropping dependents - If dropping a dependent due to a qualified life event, such as gaining other coverage, the employee has 30 days from the event to remove the dependent. Terminations beyond 30 days require approval by the Plan.