After completing an enrollment, consumers often need to make an initial payment - or set up a payment method - to their insurance provider (i.e. carrier) in order for their coverage to take effect.
In this article we cover:
Initial payments
After completing an enrollment, HealthSherpa makes it easy for consumers to make their initial payment (i.e. binder payment, first premium payment). Consumers can do this by simply visiting their consumer dashboard.
Agents can assist consumers with making their binder payment by logging into their HealthSherpa for Agents account and visiting the Follow-ups table within their consumer's Clients Details page.
Selecting the 'Pay' button will take you to the carrier's payment portal. HealthSherpa is able to offer this convenient payment link for all carriers who have set up payment integration.
Many carriers do not require consumers with $0 premium plans to have a payment method on file, but this requirement may vary carrier to carrier. Consumers with a $0 premium plan should reach out to their carrier to understand what the carrier may require.
If the 'Pay' button is unavailable, consumers should reach out to the carrier directly to make their binder payment.
Common reasons the 'Pay' button may be unavailable include:
The carrier does not have a payment integration with the Federally Facilitated Marketplace (FFM). In other words, the carrier has not shared a link for making binder payments.
The consumer was with the same carrier previously. Often when a consumer renews their coverage and decides to stay with their existing carrier, a 'Pay' button may not display.
The effective date is in the past, and therefore HealthSherpa does not have a working payment link to display.
The application does not have Enhanced Direct Enrollment (EDE) permission. The ‘Pay’ button only appears for agents who have EDE enabled within their account and who have not lost EDE permission to the the application.
The application is simply being updated. If there’s only a change in circumstance happening on the application, a binder payment is not required. In these cases, the client will continue paying their premium as they were before the update.
The application has a pending SEP verification issue (SVI). This situation should only occur for certain consumers seeking Special Enrollment Period (SEP). After resolving the SVI, the agent will need to check that the letter of coverage document has been processed. If the 'Pay' button does not appear after SVI resolution, agents should direct consumers to reach out to the carrier directly to make their binder payment.
Ongoing payments
Ongoing premiums should be paid directly through the insurance provider - not through HealthSherpa. Reach out to the carrier directly with questions regarding ongoing payment methods.
Additional Resources
If you are having any technical issues using HealthSherpa, please contact our Agent Support team at (888) 684-1373, at agent_support@healthsherpa.com, or via chat from within your account.