2. ¶1444 Determining and Collecting Premiums
Fig. 1444, continued
Premium Administration Issue Employer/ Sponsor TPA Comments?
Responsibility? Responsibility?
VI. What if an insurer passes
through a premium re-
bate, refund or other divi-
dend? Whose responsibil-
ity is it to pass through
any savings to qualified
beneficiaries?
VII. Whose responsibility is
to notify qualified benefi-
ciaries of late premium
payments? When is this
going to be done?
VIII. What happens if a pre-
mium payment is not
sufficient for the full
premium? How will the
payment be applied (e.g.,
apply as much as pos-
sible to coverage that can
be paid in full and notify
of deficiency for other
coverage?)?
IX. Who establishes the pol-
icy for insufficient funds
checks or stop payments?
X. Who is responsible for
informing providers of the
status of qualified ben-
eficiaries pending their
payment?
XI. How quickly will premium
payments be forwarded to
insurer or sent to employ-
er?
XII. Who will maintain records
of premium payments and
postmarks?
XIII. Who will respond to inqui-
ries concerning premium
payments?
XIV. What is the applicable
grace period?
1. Standard 30/45-day
periods under COBRA?
2. Plan-based grace
periods (at least as long
as COBRA)?
XV. Are the rules established
for calculating days (e.g.,
do Saturdays, Sundays
and legal holidays count)?
Page 94 • Tab 1400 August 2011 Mandated Health Benefits