Carriers Q&A - Premium Billing

With the premium billing move back to the carriers, what would the process be in members are sending payments to the state for PY26 instead of the carriers?

The specifics are being determined and details will be provided in early 2025. BeWell will submit the payment to the carrier.

What is the impact to the 820 file process with this migration? While it’s obvious that we would receive the premium payment since that would move to paying the carriers directly but that is only 1 of the many we receive. What about format, timing, naming conventions, companion guide etc.

For Plan Year 2026 coverage and beyond, 820 files for APTC payments will only be sent to issuers from CMS following the standard monthly.

What about the 820 files that NFP would send for state subsidy payments? Who would be sending those in future state?

BeWell, Health Care Authority and GetInsured are reviewing the current process for the state subsidies. We expect changes and will provide more information as those changes are finalized.

If members are in grace period during renewal time with the states current premium process will those members be passively renewed? If the members are passively renewed how will non payment terminations work if they term for non payment of 2025 premiums?

Yes, members who are actively enrolled at the time of renewal will continue to be renewed, even if they have outstanding payments due and/or are in a grace period. If members are passively renewed, and subsequently termed for non payment, you will receive a non payment term for the applicable month in PY2025. You will not receive a cancel transaction for the PY2026 passive renewal.

Carriers Q&A – Premium Billing

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Evolve 2026

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