The Prior Authorization Transparency Act amendment of 2017 has impacted how subscribers or members may be terminated from your group plan.
Termination Guidelines
- Retro-terminations are not allowed. Terminations are effective at the end of the month in which we receive the termination notice.
- No premium refunds will be given once payment is made for a member, coverage is provided and the member is listed as eligible for services.
- If the group chooses not to pay their invoice as billed (for all enrollees), to avoid delinquent status they must contact the Finance Department before the due date to request an updated invoice reflecting any terminations. Example: In June we send the July bill including Member X. Prior to the due date, the group can contact us to request an updated July invoice that does not include Member X and then pay that invoice as billed. Otherwise, an invoice may be paid as billed, and if sent with notification of termination, one month credit will be given on a future invoice.
- A premium credit will not be provided if we receive a member termination notice in the same paid month. Example: We receive a termination notice on July 10 and payment for July has already been processed. The termination is effective July 31, and there will be no premium credit.
Tips for Employers
- Sign up for automatic payment at QualChoice.com and pay insurance premium statements as billed. Adjustments for the current month will be shown on the next month's statement.
- Register for the My Account employer portal at QualChoice.com to easily manage group eligibility changes. We cannot make changes for names struck through on billing statements.
Related forms, available on QualChoice.com:
