Billing & Payment Process

Employer groups are billed monthly by Priority Health. Premium payments are due in full to Priority Health on the first day of each month for that month's coverage.

What's in the bill

The monthly bill includes:

• Account summary: A list of billing periods, premiums due and unapplied cash (if overpayment is made for retroactive adjustments)
• Current subscriber detail: A list of each covered employee, contract effective date and premium
• Retroactive adjustments: A list of premium adjustments for enrollments or terminations that affect previous periods
  

Priority Health may be able to customize an employer's bill. Call the Agent Help Line for details.

Automatic premium deduction

Employers may choose to have premiums automatically deducted from their bank accounts. Here's how it works:

• Employers receive a premium billing statement approximately 10 days prior to the deduction from their accounts.
• On the first day of every month, the designated checking or savings account will be automatically debited for the amount shown on the billing statement.

To sign a group up for automatic premium deduction:

• Download and complete a Group Automatic Deduction of Payment form (51KB PDF) for your group
• Mail the completed form to:
  

  Priority Health
  Attention Group Services
  MS 2270
  1231 East Beltline NE
  Grand Rapids, MI
  49525

• Employer groups will receive a letter in the mailing confirming their request for automatic monthly deductions. The letter will tell them the first date their premium payment will be deducted.
• If there are changes to the account, you or the group must notify Priority Health at least 5 business days prior to the last day of the month.

Back to the top

Billing terms

Information about making changes to bills, when and how premiums are prorated and conditions for terminating a health plan.

• Bill adjustments
• Grace period
• Proration
• Termination

Bill adjustments
Priority Health expects employers to pay as they are billed and to wait for retroactive adjustments to come through on the following month's billing. If an employer chooses to make adjustments to the bill:

• The group must clearly document changes or adjustments right on the invoice and submit a copy with payment. The premium payment, remittance coupon and reconciliation worksheet (if used) should be sent to the remittance address on the bill.
• Priority Health will not apply changes until the appropriate enrollment or change forms are submitted.
• Groups must send enrollment/change forms within 30 days of the change to:
  

  Priority Health
  P.O. Box 205
  Grand Rapids, MI
  49501-0205

• Do not submit enrollment changes with the premium payment.

Back to the top


Grace period
Employers have a 30-day grace period following a premium due date. If the premium is paid within that grace period, there will be no lapse in coverage.

Back to the top


Proration
Priority Health uses a half-month proration method to determine whether or not an entire month's premium will be billed.

• Enrollment proration
  • We will bill premiums for employees enrolled on day 1 through day 15 of the month for the entire month.
  • We will not bill premiums for employees enrolled on day 16 through the last day of the month for that month of coverage.
• Disenrollment proration
  • We will not bill the monthly premium for employees terminated on day 1 through day 15 of the month.
  • We will bill the monthly premium for employees terminated on day 16 through the last day of the month for that month of coverage.

Employers are responsible for reviewing their monthly billing invoices and for notifying Priority Health of any corrections within 30 calendar days after the date of each invoice. Failure to notify us promptly may limit premium adjustments.

Back to the top


Termination
Priority Health may terminate a group's health plan:

• If the premium is not paid within 30 days after the due date
• For fraud or material misstatement by the group
• If the group does not comply with Priority Health's underwriting guidelines
• If the group moves outside the Priority Health service area (if applicable)
  
• If the group ceases doing business

Also, the employer group is responsible for any and all costs and expenses, including reasonable attorney's fees, incurred by Priority Health in collecting past-due premiums.


Back to the top