With the move to an enterprise-wide modern membership system, we’re implementing and standardizing premium payment-related policies for KPIF health plan members to better align the administrative experience. Policy updates will not be proactively communicated to members since policies are captured in Evidence of Coverage (EOC) documents and other communications based on their membership experience. However, we want to make you aware of these updates.
We’re implementing a non-sufficient funds fee for returned checks or insufficient funds on electronic payments. KPIF health plan members will be sent a notification when the fee is incurred and reflected as an adjustment in their next premium billing statement. The new $20 fee applies to KPIF On and Off Exchange members in Oregon: The fee does not currently apply to members in Washington.
We’re aligning the termination for non-payment policy. Members who do not pay their current and past due premiums by the end of their grace period will be terminated retroactively to their paid-through date. This applies to KPIF On and Off Exchange members in Oregon and Washington who do not receive federal premium subsidies (APTC). Note: This is a change for KPIF On Exchange members who currently are terminated at the end of their grace period.
We’re aligning our binder premium payment due date for newly enrolled members. The binder premium due date in our new membership system is the later of (1) the enrollment effective date, or (2) the date we receive the enrollment + 30 calendar days. This applies to KPIF On and Off Exchange members in Washington. Note: This is a change for KPIF Off Exchange members.
Example: For an enrollment received on 2/16/2024 with an effective date of 3/1/2024, the binder due date is 3/17/2024 (enrollment received date + 30 calendar days).
Already in place in our systems, Oregon’s binder payment due date is defined by State regulations and will not be changed. The due date is the later of (1) the enrollment effective date + 14 calendar days, or (2) the date we receive the enrollment + 30 calendar days.
We will begin verifying the eligibility of Clark and Cowlitz County individuals who enroll during a Special Enrollment Period (SEP). This change aligns with our existing eligibility verification process for KPIF Off Exchange applicants and Kaiser Foundation Health Plan of Washington applicants.
When applying during a SEP, applicants must submit appropriate proof of a qualifying life event (QLE). We will pend applications until we receive documentation. For faster processing, it is recommended to submit the proof of a QLE document via email to SEP-validations@kp.org after the application request is submitted - there is no need to wait for a letter. To help ensure the QLE document links to the applicant's pending application, the applicant should include their Exchange ID in the email. Once verified, and upon receipt of the first month’s premium, the applicant's coverage will be effectuated. If proof of a qualifying life event is missing, or we don't get your proof in time, your application will be denied.
We will be verifying eligibility in the state of Washington, including Clark & Cowlitz counties. For KPIF On Exchange applicants who reside in Oregon, healthcare.gov will continue to verify eligibility.
Where do I send proof of my qualifying live event?
By e-mail:
SEP-Validations@kp.org
By mail:
Kaiser Permanente for Individuals and Families
P.O. BOX 23127
San Diego, CA 92193
Note: The proof of a QLE document can be sent by email after the application request is submitted - there is no need to wait for a letter. To help ensure the QLE document links to the applicant's pending application, the applicant should include their Exchange ID in the email.
What type of proof of a qualifying live event do I need to provide?
The type of proof you need to supply depends on your qualifying life event. Visit kp.org/specialenrollment or Washington Health Plan Finder to find the qualifying life event that best matches your situation.
