What's in your group's monthly bill
A typical monthly bill includes:
Section 1: Account summary
Section 2: Current subscriber detail
Section 3: Retroactive activity
See an example of a bill for:
Section 1: Account summary
A summary of the billing period, premiums due and unapplied cash (if overpayment is made for retroactive adjustments).
Determining premium
Most of the time, Priority Health will bill the group for an entire month's premium. However, when necessary, we'll prorate the monthly premium using a half-month proration method:
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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.
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Termination 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.
Section 2: Current subscriber detail
A listing, by class ID, of each covered employee and Social Security numbers, contract effective dates and appropriate premium change
What's a class?
- Classes are used to designate subsets of a health plan, such as active vs. COBRA, salary vs. hourly, different office locations.
- Groups set the classes when they establish their plans.
- It's important to use the correct class for each employee to ensure correct premium billing.
Section 3: Retroactive activity
A listing of premium adjustments for any enrollment or terminations that affect previous periods
Retroactive termination
When retroactively terminating individuals from coverage, we will reimburse fees for up to a maximum of 3 billed months from the date of termination notification.
