Individual & SHOP Timelines
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1 Individual & SHOP Timelines May 16, 2013 A service of Maryland Health Benefit Exchange
2 Purpose The intent of these timelines is to identify tasks and durations required for a successful initial enrollment. Once these timelines are agreed upon by all parties, we can use them to create business rules that will communicate to the end user what their effective date is based on their task in the timeline. 2
3 Individual timeline Three payment options Pay Maryland Health Connection for initial bill by check Pay Maryland Health Connection for initial bill online Pay Carrier for initial bill 3
4 Individual Pay Maryland Health Connection for initial bill Print bill statement Mail check with statement Individual 1. Create account, enter demographics, enroll in QHP, pay initial bill to Maryland Health Connection by mail. United States Postal Service 1. Bill in transit. Maryland Health Connection 1. Receive check, lock box processing, receive transaction file, and post payment 2. Transmit 834 & 820 during daily batch feed 3. Receive TA1, 999, and error report Carrier 1. Enroll individual 2. Print and distribute ID cards
5 Individual Pay bill on Maryland Health Connection Individual 1. Create account, enter demographics, enroll in QHP, pay initial bill on Maryland Health Connection. Maryland Health Connection 1. Process payment, receive transaction file from bank, & post payment. 2. Transmit 834 & 820 during daily batch feed. 3. Receive TA1, 999, and error report. Carrier 1. Enroll individual. 2. Print and distribute ID cards.
6 Individual Pay the carrier for initial bill Individual 1. Create account, enter demographics, enroll in QHP, send initial bill payment to carrier by mail. Maryland Health Connection 1. Transmit 834 & 820 during daily batch feed. 2. Receive TA1, 999, and error report. United States Postal Service 1. Bill in transit. Carrier 1. Process payment. 2. Enroll individual. 3. Send 834 to Maryland Health Connection. 4. Print and distribute ID cards.
7 SHOP timeline Four payment options Pay Maryland Health Connection by check Pay Maryland Health Connection online Pay Maryland Health Connection online through TPA Program 3 Pay through TPA Program 2 7
8 JAN 2014 SHOP Pay with check Employer 1. Employer creates an account, selects plan(s) or metal level, and employees are notified of open enrollment. Employee 1. Open enrollment and employees enroll in a QHP. Maryland Health Benefit Exchange staff 1. Does the group qualify as an eligible employer? 2. Conduct 75% participation check. Maryland Health Connection 1. Transmit group file to carrier(s). 2. Generate and notify employer bill is available. Employer 1. Print bill and mail with check. United States Post Office 1. Bill in Transit. Maryland Health Connection 1. Receive check, lock box processing, receive transaction file, and post payment. 2. Transmit 834 & 820 during daily batch feed. 3. Receive TA1, 999, and error report. Carrier 1. Set up group installation and enroll employees. 2. Print and distribute ID cards.
9 JAN 2014 SHOP Pay online Employer 1. Employer creates an account, selects plan(s) or metal level, and employees are notified of open enrollment. Employee 1. Open enrollment and employees enroll in a QHP. Maryland Health Benefit Exchange staff 1. Does the group qualify as an eligible employer? 2. Conduct 75% participation check. Maryland Health Connection 1. Transmit group file to carrier(s). 2. Generate bill. 3. Notify employer payment is required. Employer 1. Pay bill online. Maryland Health Connection 1. Process payment, receive transaction file from bank, & post payment. 2. Transmit 834 & 820 during daily batch feed. 3. Receive TA1, 999, and error report. Carrier 1. Set up group installation and enroll employees. 2. Print and distribute ID cards.
10 JAN 2014 SHOP TPA Program 3 Pay online Employer 1. Employer creates an account, selects plan(s) or metal level, and employees are notified of open enrollment. Employee 1. Open enrollment and employees enroll in a QHP. TPA 1. Does the group qualify as an eligible employer? 2. Conduct 75% participation check. Maryland Health Connection 1. Transmit group file to carrier(s). 2. Generate bill. 3. Notify employer payment is required. TPA 1. Pay bill online. Maryland Health Connection 1. Process payment, receive transaction file from bank, & post payment. 2. Transmit 834 & 820 during daily batch feed. 3. Receive TA1, 999, and error report. Carrier 1. Set up group installation and enroll employees. 2. Print and distribute ID cards.
11 JAN 2014 SHOP TPA Program 2 Pay online Employer 1. Employer creates an account, selects plan(s) or metal level, and employees are notified of open enrollment. Employee 1. Open enrollment and employees enroll in a QHP. TPA 1. Does the group qualify as an eligible employer? 2. Conduct 75% participation check. Maryland Health Connection 1. Transmit group file to TPA. 2. Transmit 834 to TPA. TPA 1. Collect payment. 2. Send enrollment files to carrier(s). Carrier 1. Set up group installation and enroll employees. 2. Print and distribute ID cards. TPA 1. Transmit 834 & 820 to Maryland Health Connection.
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