Comprehensive Health Insurance Pools were established to provide guaranteed issue of individual health insurance coverage for residents through their state’s legislated pool. These pools are nonprofit, risk-spreading mechanisms. Today, the need for traditional risk pools is dwindling due to the Affordable Care Act. PAI has facilitated access during this period of transition by offering the affected program members access to resources that allow them to choose a newly available plan that is appropriate for their needs. PAI continues to offer its risk pool clientele access to its experienced staff, who serve as a reliable and highly informed link between the insured individuals enrolled in the health plans and their health care service providers. Additionally, PAI serves as a full-function payment administrator that processes timely and accurate payments for thousands of individuals. We process tens of thousands of transactions annually that are associated with premiums, health benefits, and medical payment parameters that include varying deductibles and co-payments for medical and pharmaceutical claims, as well as coordination of benefits.
Monthly Premium Invoice Transactions:
PAI has processed thousands of monthly premium invoice transactions to individual members on behalf of its risk pool clients, and hundreds of delinquency notifications are processed and mailed for past due premium amounts. PAI also provides monthly outreach to members who are no longer eligible for coverage, due to non-payment of premiums, and processes all incoming accounts receivable transactions for every risk pool member.
PAI coordinates third-party payments from numerous sources, such as Insurance Premium Assistance Programs, Department of Social Services, Health Coverage Tax Credit and Trade Adjustment Act eligible individuals. Careful coordination is necessary on many third-party payee’s accounts since there are often multiple sources with a portion of the premium paid by a trust or other funding source, but with a balance also due from the program member.
For more information regarding PAI’s Comprehensive Health Insurance Pools solutions, please contact Greg Sanders