PAI understands the complexities of Subsidy Administration. Through our handling of health and prescription insurance premium subsidies, as well as Medicare Part D Coverage Gap subsidies, our experienced team is extremely knowledgeable in the nuances and variances found among a variety of programs. Our in-depth expertise includes:Skillful management of a variety of payment methodologies
- Tracking of eligible coverage plans, paid expenses, and cost-sharing arrangements
- Interaction with the Coordination of Benefits Agreement (COBA) program
- Risk analysis of potential exposure areas
The Health Coverage Tax Credit (HCTC), which provides health insurance premium subsidies to workers who become unemployed due to outsourcing according to the Trade Adjustment Act (TAA). PAI invoices for health insurance premium and processes subsidized payments received from the U.S. Department of Treasury on behalf of members qualified for the program.
State Pharmaceutical Assistance Programs (SPAPs) provide subsidies toward monthly prescription drug plan premiums as well as subsidies towards the cost of prescription drugs during the Medicare Part D Coverage Gap (Doughnut Hole) period, to eligible Medicare recipients. PAI determines eligibility, maintains enrollment and processes the subsidy payment for these programs.
The Connecticut Low-Income Premium Subsidy Program, which provides health insurance premium subsidies to those eligible participants of modest income enrolled in the Special Health Care Plan option of the Connecticut Health Reinsurance Association. PAI determines income eligibility and maintains enrollment for members in these subsidized plans.
These subsidies are administered completely in-house through all phases that start with the initial eligibility determination and end with final accounting and reporting.