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1-50: Unprocessed Payment Refunds

Jul 10, 2014

Billing might be different for your Small Group customers who are on plans that comply with the Affordable Care Act (ACA or health care reform law). Anthem bills on a monthly basis for all new Small Group business effective January 1, 2014 and after. Small groups who move to an ACA plan are affected also. In the past, they might have sent Anthem early payments for premiums before they were billed, resulting in a credit. They need to understand there’s a change, and they’ll receive a refund if they send Anthem premiums too early.

You can help your customers by reminding them they should only pay the premium amount that appears on their monthly bill – Anthem cannot apply payments for premiums that we’ve not yet sent a bill for. If a group sends Anthem extra premium payments, they will try to apply the premium for two billing cycles. After that, they’ll send them a refund for any amount that can’t be applied.

There are other reasons a customer may receive a refund. For example, members who terminate can generate a credit on the bill, because Anthem returns any premium they didn’t owe. If the credit is large enough and can’t be applied in two billing cycles, Anthem will send a refund check back to the group.

Below are some examples of when Anthem will refund unprocessed cash. If one of your clients gets a refund under such circumstances, they'd like for you to be able to explain why.

Example 1
The group is billed $1,000 monthly but remits enough premium to cover more than the current invoice, plus two additional months.

Example 2
The group has 20 subscribers with a total monthly premium of $20,000 (each subscriber is billed $1,000 per month).

Example 3
This group has seven subscribers covered under medical and vision with a total monthly premium of $6,700.

If you have any questions, please ​contact a member of your b&p Sales Team - 888.722.3373.

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