RFR Exhibit G - Calendar of Business Events~2.xlsx
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- Solicitation number
- BD-25-1175-1175C-1175L-127564
- Issued by
- Massachusetts
About this file
This file is an RFR Exhibit G Calendar of Business Events for the Massachusetts Health Connector, detailing operational timelines and processes for both Individuals & Families and Small Group health insurance enrollment programs. The document outlines the frequency and timing of critical business events throughout the plan year, beginning with carrier rate submissions in mid-May, followed by preliminary eligibility determinations in mid-August through early September, final eligibility determinations in early October through early November, and plan loading and testing in late September through early October. Open enrollment commences November 1st and concludes December 31st, with passive renewal transactions occurring in mid-November to ensure continued coverage. The calendar specifies that eligible individuals and families can shop for health and dental coverage during the open enrollment period, and that all covered members are billed monthly on the 1st for the following month's coverage, with payment due on the 23rd to maintain good standing.
The operational calendar establishes routine monthly, weekly, and daily processes to manage member eligibility, billing, delinquency, payment processing, and carrier coordination. Delinquency management, billing adjustments, and terminations for non-payment occur monthly on the 29th, while reinstatement and retro-enrollment changes are processed daily. The document includes procedures for duplicate member elimination across small group versus non-group and QHP categories on monthly and quarterly bases, as well as periodic data matching occurring weekly from February through July. Additional annual processes include 1095-A generation in January, wellness rebate submissions and processing, broker tax form distribution, and board meeting materials preparation. The calendar also references translation requirements for notices related to preliminary and final eligibility determinations, as well as service recovery communications, supporting the contract opportunity for culturally and linguistically appropriate support for readability and usability.
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Text version
Individuals & Families
| RFR EXHIBIT G - CALENDAR OF BUSINESS EVENTS | |||
| Business Event | Frequency | Description | Comments |
| Open Enrollment | |||
| Carriers submit rates to DOI | mid-May | Carriers submit rates to DOI | For informational purposes only |
| Preliminary Eligibility | Mid Aug - Early Sep | Preliminary Eligibility Determinations for the renewal year are run. Notices are generated and mailed. | Translation required |
| Final Eligibility | Early Oct- Early Nov | Eligibility determination finalized for the renewal year. Final Eligibility Notices are generated and mailed. | Translation required |
| Plan Loading and testing | Late Sep-Early Oct | Next year's plans are loaded into the system. Testing is preformed to verify accurate plan mapping | For informational purposes only |
| Open Enrollment starts | November 1st | Eligible individuals and enrollees able to shop for health and dental coverage for the next plan year | |
| Passive renewal transactions | Mid November | Members are mapped to next year's most similar plan and enrollment transactions are sent to carriers to ensure continued coverage even if members do not shop. | |
| December Bill Run for Jan Coverage | December 1st | Billing runs for Jan Coverage. Invoices are generated and mailed (and posted to payment portal) | |
| Payment due date for January coverage | December 31st | For calendar year coverage, members must pay by 12/31 | |
| Open Enrollment Ends | December 31st | Shopping is closed for the renewal year coverage (without an SEP) | |
| Closed Enrollment | |||
| Closed Enrollment Terminations | Monthly April -November (between 22-24th) | Terminate members who have failed to submit proof that they qualify for a Special Enrollment Period by 90 day deadline | |
| Periodic Data Matching | Weekly Feb - July | Expirations (internal term is timeclock) for Periodic Data Matching that runs 30 days after a case was initially picked up for a data match discrepancy and noticed. | |
| Eligibility verification close out for non-response | Twice Monthly up until the 15th of the month. | If member does not submit documents they will have their eligibility re-determined based on data sources, which could result in a subsidy loss or coverage termination. | No expiration batches after the 15th of the month. |
| Small Group vs Non Group | Quarterly | Eliminate duplicate members in small group vs non group | |
| QHP vs QHP | Monthly | Eliminate duplicate members in QHPs | |
| QHP vs MassHealth | Monthly | Eliminate duplicate members in QHPs vs Mass Health | |
| Billing | Monthly on the 1st | All enrolled members are billed for the next coverage month. | For example: in May, we bill members for June coverage and payment is due on May 23rd to remain in good standing and avoid delinquency. |
| Billing | Daily | The following billing activities occur daily: |
- Generate and email/mail initial bills to those who shopped for new enrollment and need to make a binder payment to enroll
- Generate and email/mail recurring billing to members who were effectuated retroactively and were not billed for their monthly premium on the most recent 1st of the month
| - Generate and email/mail premium change bills to all members who had a premium change since their most recent recurring monthly bill. | Example of premium change is premium increase or decrease due to change in program eligibility, or premium change due to updated family composition, such as adding or removing a dependent. | |||
| Reinstatement | Daily | Process reinstatement after termination for non-payment within 35 days | Some reinstatements are automatic and are processed upon member making a payment, others require member to call and request it over the phone | |
| Retro-Terms, Retro-Adds | Daily | Process daily after Carrier approvals are received where applicable | Most retro adds are processed by the contact center staff in HIX directly, others have to wait for carrier approval which contact center staff request from carriers | |
| 1095-A Generation | January | 1095s run for the previous year's coverage, mailed not later than January 31st | ||
| 1095-A Correction | Weekly | Corrections and Voids are issued when member enrollment changes are processed through the systems | ||
| Cancel enrollments that did not effectuate | Monthly | Plan selections are canceled for members who selected a plan but have not made a binder payment sufficient to effectuate coverage by the payment due date | This process runs on the 29th. | |
| Delinquency | Monthly | If subscriber is not paid up-to-date, they are made delinquent. Subsidized subscribers who are already delinquent are advanced further in delinquency making their status suspended. Carriers are notified of suspended status and may deny pharmacy benefits and claims | This process runs on the 29th | |
| Delinquency notices | Monthly | Delinquency notices are generated and mailed/sent electronically to subsidized and unsubsidized subscribers who are in various stages of delinquency as well as those whose coverage is terminated for non-payment | Notices are generated on the 29th and mail within 3 business days | |
| Terminations for non-payment | Monthly | Coverage is terminated for non-payment for delinquent subscribers who have not made a payment to bring their account to good standing. Carrier is informed of termination. | This process runs on the 29th | |
| Grace period write-offs | Monthly | Subsidized members whose coverage ended and who have a grace period balance on their account have the balance removed so they may enroll in coverage again | ||
| Payment Due Date | Monthly on the 23rd | Payments are due from all premium paying members to maintain coverage in good standing as well as for binder payments to effectuate coverage for new enrollments | ||
| AutoPay is charged | Monthly on the 15th and 23rd | Members who are signed up for AutoPay are charged the amount according to their Autopay setup. Members receive a confirmation email with amount 5 days before charge is processed through the bank | ||
| Member Requested Refunds | 2-4 times per week | After requested by members, refunds are validated and issued to members to the same payment method as the payment was made | ||
| Orphaned refunds | Every two weeks | Payments that cannot be applied to any member account after they are researched are sent back to payer via the same payment method as the payment made | ||
| Connector-initiated refunds, aka "automated" | Monthly | Refunds are sent monthly to members no longer enrolled or members who have paid beyond the current plan year. Depending on the refund, these are electronic or paper | These are refunds we send that are not requested by members | |
| Board meeting | Monthly/bimonthly | Board materials are produced and placed online | Remediation required | |
| Annual report and other policy reports | Ad hoc | Reports detailing policy or data of interest | Remediation required | |
| Service recovery | Ad hoc | Notices to members clarifying account status and impacts due to service issues | Translation required |
&"-,Bold"RFR Exhibit G - Calendar of Business Events
Page &P
Small Group
| RFR EXHIBIT G - CALENDAR OF BUSINESS EVENTS | |||
| Business Event | Frequency | Description | Comments |
| Business Event | Frequency | Description | Comments |
| New Enrollment | |||
| Employer Account Creation | Daily | Employer creates an account for their business and uploads or inputs a roster of employees. | |
| Employer Publishes Benefit Package | Monthly | Plan shopping is available for two coverage months at a time. Deadline is 10th calendar day of each month. | Public facing is the 10th; system rule is the 15th. |
| Employer Verification | Daily | Employer must upload verification documents and admin reviews, approves, denies | |
| Employee Enrolls or Waives coverage | Monthly | Deadline is 20th calendar day of each month. | Monthly 843 transactions |
| Renewal | |||
| Passive Renewal Transactions | Monthly | Members are mapped to their renewal plan and enrollment transactions are sent to carriers to ensure continued coverage even if members do not shop. | Monthly 843 transactions |
| Renewal Period Starts | Monthly | Employer receives notice and are able to make changes to their benefit plan 60 days prior to their renewal date | Small Group enrollments are on a plan year (as opposed to calendar year renewals for Individuals and Families) and therefore occur monthly on the groups 12 month anniversary date |
| Billing | |||
| Invoice Generation | Monthly on the 1st | Existing and renewing members are billed for the next coverage month. Mid month changes or retroactivity events are billed in the next billing cycle | Existing: in May, we bill members for June coverage and payment is due on May 23rd to remain in good standing and avoid delinquency. Mid month changes: premium increase or decrease due to change in program eligibility, or premium change due to updated family composition, such as adding or removing a dependent. |
| Binder Payment | Monthly on the 21st | New groups are billed for the effectuating months coverage | |
| 820 Transaction | Monthly on the 5th business day | Payment file sent to carriers | |
| Delinquency | Monthly | If employer is not paid up-to-date, they are made delinquent. Carriers are notified of delinquent status and may deny pharmacy benefits and claims | This process runs on the 1st |
| Delinquency notices | Monthly | Delinquency notices are generated and mailed/sent electronically employers who are in various stages of delinquency as well as those whose coverage is terminated for non-payment. If an employer is more than 30 days delinquent, a notice is also sent to the employees advising that they are at risk of losing coverage. | Notices are generated on the 1st and mail within 3 business days |
| Terminations for non-payment | Monthly | Coverage is terminated for non-payment for delinquent subscribers who have not made a payment to bring their account to good standing. Carrier is informed of termination. | This process runs on the 1st |
| Payment Due Date | Monthly on the 23rd | Payments are due from groups to maintain coverage in good standing. This applies to binder payments to effectuate coverage for new enrollments, ongoing monthly payments and renewal payments. | |
| AutoPay is charged | Employers select the withdrawal date | Employers who are signed up for AutoPay are charged the amount according to their Autopay setup. | |
| Member Requested Refunds | Weekly | After requested by members, refunds are validated and issued to employers. | |
| Qualifying Events and Mid-Year Changes | |||
| Reinstatement | Daily | Process reinstatement after termination, following carrier retro guidelines (within 90 days). | |
| Retro-Terms, Retro-Adds | Daily | Process retro enrollment changes for qualifying events, following carrier retro guidelines (within 90 days). | |
| Employee or Dependent Changes | Monthly | Employees or dependents may be added or removed from an employers benefit package. Changes are reflected on the next monthly invoice. | |
| 834 Transaction | Daily | Enrollment file sent to carriers | |
| Brokers | |||
| Broker Certification | Monthly | New brokers must provide verification documentation and receive training materials prior to being certified to support small businesses with HCB enrollment. | |
| Broker Commissions | Monthly | Brokers receive monthly commissions payments based on covered lives enrolled in groups they represent. | |
| Broker Tax Forms | Annual | Brokers who receive at least $600 in commissions annually, receive a tax form from the Health Connector. | |
| Wellness | |||
| Wellness Eligibility | Monthly | New groups who meet Wellness eligibility criteria receive a notice advising of opportunity to receive rebates and/or gift cards if they complete required wellness activities. | |
| Employer Wellness Rebate | Annual | Employers submit payroll data and proof that wellness activities were completed in order to receive a 15% rebate for their contributions towards health coverage for employees who completed the required eligibility wellness activities. | |
| Employee Wellness Gift card | Annual | Employees submit proof that they completed required wellness activity to receive a $100 gift card from the Health Connector. This process can happen at anytime during the plan year once they complete the qualifying wellness activity | |
| Plan Management | |||
| Plan Loading and Testing | Quarterly | Plans are loaded into the system. Testing is preformed to verify accurate plan details. | |
| Other | |||
| Board meeting | Monthly/bimonthly | Board materials are produced and placed online | Remediation required |
| Annual report and other policy reports | Ad hoc | Reports detailing policy or data of interest | Remediation required |
| Service recovery | Ad hoc | Notices to employers and/or employees clarifying account status and impacts due to service issues | Translation required |
File details come from the government source that posted it. Updated .