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Table of Contents
TABLE OF CONTENTS
COBRA &
DIRECT PAY
JOB AID
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10/2014
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10/2014
Table of Contents ............................................................................................................................ 3
Direct Pay ..................................................................................................................................... 5
Invoicing & Terms of Payment .................................................................................................... 5
Premium Remittance .................................................................................................................. 6
Non-Sufficient Funds and Stop Payment .................................................................................... 6
Cancellation of Coverage ............................................................................................................ 7
for Non-Payment .................................................................................................................... 7
At Participant’s Request.......................................................................................................... 7
Other Correspondence ............................................................................................................... 7
Carrier Notification ..................................................................................................................... 7
Appeals ........................................................................................................................................ 7
Contact Information .................................................................................................................... 7
Sample Direct Pay Documents .................................................................................................... 8
Sample Invoice (p.1): .............................................................................................................. 8
Sample Invoice (p. 2) ............................................................................................................... 9
Sample Friendly Reminder Letter ......................................................................................... 10
Sample Short Pay Letter........................................................................................................ 11
Sample Termination Letter ................................................................................................... 12
COBRA Services ........................................................................................................................ 14
COBRA Qualified Events Package Generation .......................................................................... 14
COBRA Initial Rights Notification .......................................................................................... 14
COBRA Election Packet ......................................................................................................... 14
Invoicing & Terms of Payment .................................................................................................. 15
Premium Remittance ................................................................................................................ 16
Non-Sufficient Funds & Stop Payment Process ........................................................................ 16
Cancellation for Non-Payment or at Participant’s Request ...................................................... 16
For Non-Payment .................................................................................................................. 16
At Participant’s Request........................................................................................................ 16
Coverage Effective Date ............................................................................................................ 17
Carrier Notification ................................................................................................................... 17
Appeals ...................................................................................................................................... 17
Open Enrollment ....................................................................................................................... 17
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10/2014
Other Correspondence ............................................................................................................. 17
Accessing ADP’s COBRA Site ..................................................................................................... 18
Contact ...................................................................................................................................... 18
Sample COBRA Documents ....................................................................................................... 18
Sample Ongoing Cover Letter with Invoice (p.1) .................................................................. 19
Sample Ongoing Cover Letter with Invoice (p. 2) ................................................................. 20
Sample COBRA Election Package .......................................................................................... 21
Sample General Notice of COBRA Rights .............................................................................. 28
Samples Insignificant Shortfall Letter ................................................................................... 30
Sample Significant Shortfall Letter ....................................................................................... 31
Sample Welcome Letter ........................................................................................................ 32
Sample Confirmation Letter .................................................................................................. 34
Sample Early Termination Letter .......................................................................................... 36
Sample Termination Conversion Letter ................................................................................ 37
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Direct Pay
DIRECT PAY
In certain circumstances, a member may be required to be billed for the cost of their health care
coverage. When this occurs, the following applies:
Invoicing & Terms of Payment
All invoices and related correspondence are generated by ADP, and sent via regular postal mail.
Invoices are generated on or before the 7th of the month and mailed on or before the 10
th
of the month for the following month’s premium.
Payment is due the first of the following month.
Example:
o Coverage month = December
o Invoice generated by November 10
o Payment due = December 1
Any payments made in advance (prepayment) or made late will be reflected in the
following month’s invoice. Note: Prepayments cannot be made online.
There is a 30-day grace period from the payment due date. Members are strongly
encouraged to make payments by the due date each month to ensure continuation of
coverage without interruption.
Sample invoice (see the Direct Pay samples section for a full statement):
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Direct Pay 10/2014
Premium Remittance
Monthly premium payments can be remitted through one of the following methods:
One-time or Recurring Online Payment through the secure online payment application
(Selfpay), available 24 hours a day, 7 days a week. Refer to the Selfpay message below
as it appears on the monthly invoice.
By check, mailed to:
ADP
Continuation Services
P.O. Box 105413
Atlanta, GA 30348-5413
Premium payments should be placed in the return envelope along with the payment
invoice to expedite processing, and mailed to the address located on the payment
invoice. Failure to include the payment invoice with the premium payment will delay
processing of payment.
Non-Sufficient Funds and Stop Payment
In the event of a returned check due to non-sufficient funds or a stop payment being placed on
the check, ADP will send a letter to the participant requesting resubmission of payment.
Coverage will be cancelled, as noted below, for non-payment beyond the grace period.
PAY ONLINE with Selfpay
Paying online is easier than mailing your payment and you'll receive
an email confirmation of your payment from our bank, JP Morgan
Chase. Don't risk a lapse in coverage because of a delay in mail
delivery.
Sign up for Your Free Selfpay Account:
1. Visit https://selfpay.adp.com
2. Click "Don't have a password yet?"
3. Enter the Account Number from page 1 of your invoice.
4. Enter the Invoice Number and Amount of your latest invoice.
5. Receive validation and your login and password, which you'll
use to access Selfpay.
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Direct Pay 10/2014
Cancellation of Coverage
FOR NON-PAYMENT
Coverage is cancelled at the end of the grace period if payment has not been received. The
grace period for Direct Pay payment is 30 days.
AT PARTICIPANT’S REQUEST
A participant may request that coverage be cancelled by calling SHBP Member Services or
submitting a letter in writing to:
ADP
Continuation Services
P.O. Box 34240
Louisville, KY 40232
Other Correspondence
Any correspondence not related to payments should be sent to the address below. No
premium payments should to be sent to this address.
ADP
Continuation Services
P.O. Box 34240
Louisville, KY 40232
Carrier Notification
ADP is responsible for notifying carriers of coverage updates. Allow 7 – 10 business days from
the time the payment has been received in order for coverage to be active with the carrier.
Note: This time frame includes the processing of payments received.
Appeals
A member whose coverage has been cancelled for non-payment may contact SHBP Member
Services at 1-800-610-1863 to discuss the appeal process. ADP will provide Tier 1 appeals
support based on pre-established guidelines with SHBP. If a resolution to the appeal cannot be
reached through Tier 1 support, members will be instructed to submit an appeal to SHBP at
1-866-828-4796 within 60 days of the cancellation notice. The appeal must include the reason
and pertinent information.
Contact Information
Call SHBP Member Services for questions related to Direct Pay at 1-800-610-1863.
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Direct Pay 10/2014
Sample Direct Pay Documents
Important: Sample Direct Pay documents are included for general reference only to
understand the information that is typically sent to participants. These documents are subject
to change, and should not be shared directly with any participants.
SAMPLE INVOICE (P.1):
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Direct Pay 10/2014
SAMPLE INVOICE (P. 2)
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Direct Pay 10/2014
SAMPLE FRIENDLY REMINDER LETTER
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Direct Pay 10/2014
SAMPLE SHORT PAY LETTER
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Direct Pay 10/2014
SAMPLE TERMINATION LETTER
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Direct Pay 10/2014
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COBRA Services
COBRA SERVICES
COBRA services, including notification of COBRA rights upon hire/health care benefits eligibility,
continuation of health care, and the receipt and distribution of funds is administered by ADP,
LLC.
COBRA Qualified Events Package Generation
COBRA INITIAL RIGHTS NOTIFICATION
Once a member elects health care coverage, ADP generates and mails a COBRA Initial Rights
Notice (IRN).
The COBRA IRN is sent to the employee and a covered spouse, if applicable. See the
Sample COBRA Documents section for a sample packet.
COBRA IRN mailings are processed daily.
COBRA ELECTION PACKET
Once a termination event is entered in the SHBP Enrollment Portal (either through IDM or via
file upload), ADP generates and mails a COBRA Election Packet to the member and/or qualified
beneficiaries. See the Sample COBRA Documents section for a sample packet.
1. The COBRA Election Packet includes the information needed to make an election to
continue coverage.
2. Both the election and payment can be made online via ADP’s secure application.
3. The first premium is due within 45 calendar days of the election.
4. Eligibility is passed to the carrier once the initial payment is received.
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COBRA Services 10/2014
The following information is an excerpt from the COBRA Election packet regarding fast
activation for COBRA. Going online is the fastest way for members to make their election and
make payment.
You have up to 45 calendar days from the date you elect COBRA within which to make your first
required premium payment. However, to activate your coverage as quickly as possible, it is
recommended that you make your first payment at the same time as your election so your
insurance carrier can be notified sooner.
To elect and pay online:
OR, Mail completed form to:
OR, Fax completed form to:
http://www.benedirect.adp.com
ADP COBRA Services
P.O. Box 2698
Alpharetta, GA 30023-2698
Make checks payable to ADP
COBRA Services
Note: Future payments will
be sent to a different
address, which will be noted
on your next bill.
1-770-619-7160
Invoicing & Terms of Payment
All COBRA invoices and related correspondence are generated by ADP and sent via regular postal
mail.
Invoices are generated 25 days in advance of the due date for the following month’s
premium.
Payment is due on the first of the month.
Example:
o Coverage month = December
o Invoice generated on or about the November 5th
o Payment due = December 1
Any payments made in advance (prepayment) or made late will be reflected in the
following month’s invoice. Note: Prepayments cannot be made online.
The initial payment is due 45 calendar days from the date of the election.
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COBRA Services 10/2014
Sample invoice:
Premium Remittance
Participants can make a one-time payment online or access account information through ADP
COBRA at https://www.benedirect.adp.com. Participants may also send in a check to the
address on the invoice.
Non-Sufficient Funds & Stop Payment Process
In the event of a returned check due to non-sufficient funds or a stop payment being placed on
the check, ADP will send a letter to the participant and request resubmission of payment.
Coverage will be cancelled as noted below for non-payment beyond the grace period.
Cancellation for Non-Payment or at Participant’s Request
FOR NON-PAYMENT
Coverage is cancelled at the end of the grace period if payment has not been received. The
grace periods for COBRA participants are:
Initial election grace period: 60 calendar days
Initial payment grace period: 45 calendar days
Subsequent payment grace period: 31 calendar days
AT PARTICIPANT’S REQUEST
A participant may request that coverage be cancelled by calling SHBP Member Services or
submitting a letter in writing to:
ADP COBRA Services
P.O. Box 2968
Alpharetta, GA 30023-2968
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COBRA Services 10/2014
Coverage Effective Date
Coverage goes into effect once the election is made, even if first payment has not yet been
received. However, confirmation of coverage is not sent to the carrier until the premium
payment is processed by ADP. In addition, if the initial premium is never received by ADP, then
the COBRA coverage is terminated retroactively back to the last day of active coverage.
Carrier Notification
ADP sends eligibility data to carriers. Allow 7 – 10 business days from the time the payment has
been received in order for coverage to be active with the carrier. ADP recommends that
members call the number on their insurance card to confirm that COBRA coverage has been
activated with the carrier. Previously denied claims can be reprocessed by carriers once COBRA
coverage has been activated. Note: This time frame includes the processing of payments
received.
Appeals
A member whose coverage has been cancelled for non-payment may contact SHBP Member
Services at 1-800-610-1863 to discuss the appeal process. ADP will provide Tier 1 appeals
support based on pre-established guidelines with SHBP. If a resolution to the appeal cannot be
reached through Tier 1 support, members will be instructed to submit an appeal to SHBP at
1-866-828-4796 within 60 days of the cancellation notice. The appeal must include the reason
and pertinent information.
Open Enrollment
ADP generates Open Enrollment packets (including Summary of Benefits and Coverage forms
and other materials that may be required and provided by SHBP). Participants may make a
change via SHBP Member Services or fax.
Other Correspondence
Any correspondence not related to payments should be sent to the address below. No
premium payments should to be sent to this address.
ADP
PO Box 2968
Alpharetta, GA 30023-2968
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COBRA Services 10/2014
Accessing ADP’s COBRA Site
Participants can access the site to:
Make a one-time payment
Request eligibility updates to carriers
View health plan information
Get assistance and answers to questions
Logon to https://www.benedirect.adp.com
Contacts
Call SHBP Member Services for questions related to COBRA @ 1-800-610-1863.
Sample COBRA Documents
Important: Sample COBRA documents are included for reference only to understand the
information that is typically sent to participants. These documents are subject to change, and
should not be shared directly with any participants.
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COBRA Services 10/2014
SAMPLE ONGOING COVER LETTER WITH INVOICE (P.1)
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COBRA Services 10/2014
SAMPLE ONGOING COVER LETTER WITH INVOICE (P. 2)
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COBRA Services 10/2014
SAMPLE COBRA ELECTION PACKAGE
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COBRA Services 10/2014
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COBRA Services 10/2014
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COBRA Services 10/2014
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COBRA Services 10/2014
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COBRA Services 10/2014
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COBRA Services 10/2014
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COBRA Services 10/2014
SAMPLE GENERAL NOTICE OF COBRA RIGHTS
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COBRA Services 10/2014
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COBRA Services 10/2014
Sample Insignificant Shortfall Letter
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COBRA Services 10/2014
SAMPLE SIGNIFICANT SHORTFALL LETTER
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COBRA Services 10/2014
SAMPLE WELCOME LETTER
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COBRA Services 10/2014
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COBRA Services 10/2014
SAMPLE CONFIRMATION LETTER
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COBRA Services 10/2014
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COBRA Services 10/2014
SAMPLE EARLY TERMINATION LETTER
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COBRA Services 10/2014
SAMPLE TERMINATION CONVERSION LETTER
