Payroll Systems and Benefitfocus Enrollment

The State Health Plan has been working with many of the employing units with premium discrepancies older than 60 days. We have made a lot of progress. However, we continue to see some discrepancies linger for months. The primary cause appears to be a disconnect between the enrollment in Benefitfocus and the employing unit payroll systems.   It is absolutely essential that enrollment be maintained in the Benefitfocus system as this is what drives your monthly premium bill. It is the responsibility of each employing unit to reconcile their premium bill with their Benefitfocus enrollment. If a discrepancy is found, it must be corrected in the Benefitfocus enrollment tool, eBN, by the employing unit.
 

Late Premium Payments on Individual Members

In researching older delinquencies it has become apparent that another issue for some employing units is collecting premiums for members who are on some sort of leave. In some instances, employing units may even offer payment plans for these employees.   While the specifics of the collections may vary by employing unit, it is essential that the employing unit remit payment to Blue Cross and Blue Shield of North Carolina (BCBSNC) for the member in full and on schedule.   As noted in earlier reminders about arrears, a member cannot stay on the Plan longer than one billing cycle without premiums being paid in full. Any members who experience a lapse in premium payment whose balance is not brought current by the next billing cycle will be terminated from the Plan. The termination date will be one day prior to the effective date of the first missed payment.
 
Example resulting in automatic member termination:

• January - August - Employing unit pays member A's premium January through August.
• September - Employing unit does not terminate member A's coverage effective September 1, nor is the September premium paid.
• October - Employing unit does not terminate member A's coverage, nor is September and October premium paid.
  Member will be automatically terminated August 31.

Example that avoids member termination:

• January - August - Employing unit pays member A's premium January through August.
• September - Employing unit does not terminate member A's coverage effective September 1, nor is the September premium paid.
• October - Employing unit pays member A's September and October premium.
  Member is paid in full and has no lapse in coverage.

Members who are terminated due to a lapse in premium payment by the employing unit cannot be reinstated unless the premium is paid in full, which includes the current month.
 

Due Dates

As we have noted before, discrepancies resulting in payment delinquencies may result in claims holds. As we have also emphasized, all premium payments should be received by the first of every effective month. To ensure that your payment is processed correctly, payments should be submitted in the envelopes provided. There is a specific envelope for reconciliations and one for regular payments. Historically, BCBSNC has both called and sent emails to employing units in an attempt to follow up on delinquencies. These follow-ups, along with the overage/shortage sheets, were the primary communication methods for discrepancies and delinquencies. To ensure a prompt resolution, we are instituting a more formal escalation notification process.
 

Escalations  

Premium payments are due by the first of the effective month. Premium payments must reflect corrections from any discrepancies from the previous month's premium payment.  

• Premium payments not received by the end of the first week of the effective month will be escalated to the primary HBR contact.
• Premium payments not received by the end of the third week of the effective month will be escalated to the fiscal officer for the employing unit.
• Premium payments not received by the end of the effective month will be escalated to the fiscal officer.  Additionally:
  • A list of all delinquent LEAs and Charter Schools will be sent to DPI.
  • A list of all delinquent universities will be sent to UNC General Administration.
  • A list of all delinquent community colleges will be sent to the North Carolina Community College System Office's Division of Business and Finance.

The first round of escalation emails will go out this Friday, May 11. Any employing unit whose May premium has not been received and/or there is a discrepancy older than 60 days will receive the email. Claims incurred after the date of the delinquency (claims incurred May 1 or later, for May premium delinquencies) may also be placed on hold until the delinquency has been resolved.