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A premium is the monthly amount a consumer pays for health insurance. After an enrollment submission, consumers often need to make an initial premium payment or set up a payment method with their carrier for coverage to take effect.
In this article we’ll cover:
Payment functionality is not available within HealthSherpa Enrollee Assistance Full-Service account types.
Initial payments
An initial payment is the first premium payment a consumer makes to their carrier after an enrollment submission. It’s also called a binder payment or first month’s premium. This payment is made directly to the carrier and is often required for coverage to take effect.
The Clients page contains consumers connected to the HealthSherpa account who have successfully submitted an enrollment.
Using HealthSherpa, agents can assist consumers with making their initial payment if the consumer is already listed on the Clients page. To assist a consumer who is not already on the Clients page, with consent, agents can search & claim the consumer’s existing application.
Step 1: Open the consumer record
Step 1: Open the consumer record
To assist a consumer who is already listed on the Clients page, select the consumer’s name to open their consumer record.
The Details tab is the default view when an agent opens a consumer record from the Clients page.
Step 2: Select the Pay button
Step 2: Select the Pay button
Find the Follow-ups section, and select Pay to access the carrier's payment portal.
HealthSherpa only displays the Pay button for carriers who have set up payment integration.
$0 premium plans
Many carriers do not require consumers with $0 premium plans to have a payment method on file. Requirements vary by carrier, so consumers with a $0 premium plan should contact their carrier to confirm what is required.
If the Pay button is unavailable
If Pay is unavailable, consumers should contact the carrier directly to make their binder payment.
Reasons the Pay button may be unavailable include:
The agent no longer has an active Enhanced Direct Enrollment (EDE) sync to the application.
The carrier does not have payment integration with the Federally Facilitated Marketplace (FFM). This means the carrier has not shared a link for making binder payments.
The consumer was enrolled with the same carrier previously. When a consumer renews coverage and stays with the same carrier, Pay may not display.
The coverage effective date is in the past. In these cases, HealthSherpa does not have a working payment link to display.
The application is being updated. If there is only a change in circumstance on the application, a binder payment is not required. The client should continue paying their premium the same way they did before the update.
The application has a pending Special Enrollment Period (SEP) Verification Issue (SVI). This should only occur for certain consumers seeking an SEP. After the SVI is resolved, the agent should confirm the letter of coverage document has been processed. If Pay still does not appear, direct the consumer to contact the carrier directly to make their binder payment.
Ongoing payments
Consumers often need to make ongoing premium payments for their coverage to remain in effect.
Ongoing premiums should be paid directly through the carrier, not through HealthSherpa. If a consumer has questions about ongoing premium amounts, due dates, or payment methods, they should contact the carrier directly.
Additional resources
For help using HealthSherpa or for other assistance, contact Agent Support. Agent Support is available by phone at (888) 684-1373, by email at Agent_Support@HealthSherpa.com, or by chat directly from your account.