Your Health Idaho

Your Health Idaho (YHI) has reviewed the case referenced in complaint # [redacted] , and found that the consumer had contacted YHI to enroll in a policy with an effective date of February 1, Our system indicated that the enrollment was sent to Mountain Health (MHC) on January and again on February Mountain Health has stated that Ms [redacted] was sent notification of pending termination due to failure to pay a past due amount on her accountMHC states that no payment was made to correct an amount due because the consumer did not pay January’s premium and the policy was terminated Ms [redacted] had insurance coverage for Her plan was automatically renewed for Because of that Ms [redacted] was responsible for a January premium paymentLate in December, Ms [redacted] changed her plan, it was too late for a January start date, so the plan went into effect on February Ms [redacted] , was still responsible for the January premium Ms [redacted] states that a YHI representative advised her not to pay the premium that was due for January for their existing plan but Ms [redacted] did not provide the date of the conversation nor name of the employee who advised her not to payThis is against YHI policy which states: Renewals 5: Carrier Use of Payment Updated 5/1/- CFR 155.400; New enrollments completed during an eligible enrollment period require the first full payment to be made by the initial payment due date for coverage to become effective Renewed plans are considered a continuation of coverage and do not need an initial binder payment for coverage to be effectiveThe 90-day grace period for payment carries over for renewed enrollments if APTC is used to lower monthly premiumsIf a delinquency exists on the account, carriers may apply any payments received to the delinquency YHI records indicate that on February 11, the consumer was advised to request confirmation of the conversation advising non-payment from the Department of Health and Welfare (DHW), which was acting as YHI’s call centerOn February 11, YHI also requested confirmation of this call from DHW On March 24, DHW stated that they did not have a record of that conversation in their systemYHI never received confirmation from Ms [redacted] of that conversation On June 10, 2016, Ms [redacted] called and stated that MHC told her that the family did not have insurance in February or March and would not accept paymentMs [redacted] asked to have her insurance start date changed to April 1, As per YHI policy, she was referred to MHC for confirmation that this was allowable On June 15, MHC contacted YHI to confirm effective date of February 1, On October 24, Ms [redacted] called YHI to find out why her premiums were not being paidYHI’s records indicate the Ms [redacted] had coverage effective February 1, YHI was not aware of the past due premium and MHC’s attempt to collect those monies According to MHC, the member was notified on January 8, that she owed a past due amount of $The member changed plans at the end of December 2015, her new plan would begin in February of 2016, and the consumer owed MHC the premium for the plan she had in MHC also stated that the consumer was notified again in July indicating that she then owed $MHC states the member did not make the outstanding payments in the allotted time frame and the policy was canceled MHC terminated Ms [redacted] for non-payment of past due premium but had not notified YHI of the termination, that is why our records indicated a policy start date of February 1, YHI does not collect payments for plan premiums and relies on notification from carriers of plan termination for non-paymentMs [redacted] does need to resolve this issue with MHC since this is a termination by the carrier for non-payment of premium

Thank you for forwarding this issue to Your Health IdahoWe regret the delay is resolution of this problemThe issue regarding this consumer's was resolved on 3/14/and a 1095-A was generated for this consumerWe have verified that the form is available to the consumer in their secure inbox at Your Health Idaho.Thank you.Your Health Idaho

Your Health Idaho (YHI) has reviewed the case referenced in complaint # [redacted], and found that the consumer had contacted YHI to enroll in a policy with an effective date of February 1, 2016. Our system indicated that the enrollment was sent to Mountain Health Co-op (MHC) on January 7 and again on...

February 6.
Mountain Health Co-op has stated that Ms. [redacted] was sent notification of pending termination due to failure to pay a past due amount on her account. MHC states that no payment was made to correct an amount due because the consumer did not pay January’s premium and the policy was terminated.
Ms. [redacted] had insurance coverage for 2015. Her plan was automatically renewed for 2016. Because of that Ms. [redacted] was responsible for a January premium payment. Late in December, Ms. [redacted] changed her plan, it was too late for a January 1 start date, so the plan went into effect on February 1.
Ms. [redacted], was still responsible for the January premium.
Ms. [redacted] states that a YHI representative advised her not to pay the premium that was due for January for their existing 2015 plan but Ms. [redacted] did not provide the date of the conversation nor name of the employee who advised her not to pay. This is against YHI policy which states:
Renewals 5: Carrier Use of Payment
Updated 5/1/16 - 45 CFR 155.400; 156.270
New enrollments completed during an eligible enrollment period require the first full payment to be made by the initial payment due date for coverage to become effective.
Renewed plans are considered a continuation of coverage and do not need an initial binder payment for coverage to be effective. The 90-day grace period for payment carries over for renewed enrollments if APTC is used to lower monthly premiums. If a delinquency exists on the account, carriers may apply any payments received to the delinquency.
YHI records indicate that on February 11, 2016 the consumer was advised to request confirmation of the conversation advising non-payment from the Department of Health and Welfare (DHW), which was acting as YHI’s call center. On February 11, YHI also requested confirmation of this call from DHW.
On March 24, DHW stated that they did not have a record of that conversation in their system. YHI never received confirmation from Ms. [redacted] of that conversation.
On June 10, 2016, Ms. [redacted] called and stated that MHC told her that the family did not have insurance in February or March and would not accept payment. Ms. [redacted] asked to have her insurance start date changed to April 1, 2016. As per YHI policy, she was referred to MHC for confirmation that this was allowable.
On June 15, MHC contacted YHI to confirm effective date of February 1, 2016.
On October 24, Ms. [redacted] called YHI to find out why her premiums were not being paid. YHI’s records indicate the Ms. [redacted] had coverage effective February 1, 2016. YHI was not aware of the past due premium and MHC’s attempt to collect those monies. 
According to MHC, the member was notified on January 8, that she owed a past due amount of $425.76. The member changed plans at the end of December 2015, her new plan would begin in February of 2016, and the consumer owed MHC the premium for the plan she had in 2015.
MHC also stated that the consumer was notified again in July indicating that she then owed $726.68. MHC states the member did not make the outstanding payments in the allotted time frame and the policy was canceled. 
MHC terminated Ms. [redacted] for non-payment of past due premium but had not notified YHI of the termination, that is why our records indicated a policy start date of February 1, 2016
YHI does not collect payments for plan premiums and relies on notification from carriers of plan termination for non-payment. Ms. [redacted] does need to resolve this issue with MHC since this is a termination by the carrier for non-payment of premium.

Thank you for forwarding this issue to Your Health Idaho. We regret the delay is resolution of this problem. The issue regarding this consumer's 1095 was resolved on 3/14/16 and a 1095-A was generated for this consumer. We have verified that the form is available to the consumer in...

their secure inbox at Your Health Idaho.Thank you.Your Health Idaho

RE: ID [redacted]Dear [redacted]:Thank you for your letter, dated July 16, regarding a customer's concern over a refund due tocancellation of insurance. The refund was delayed due to technical issues updating the address withBlue Cross of Idaho.The customer's address has now been updated with Blue Cross of...

Idaho {BCI). As a result, BCI will beissuing the customer a refund to their new address.The consumer can contact Blue Cross of Idaho with additional questions.Thank you,Jody O[redacted]Your Health Idaho208.991.4911