WAHBE PREMIUM SPONSORSHIP PROGRAM
For 2015 Coverage Year
Background
In 2010, Congress passed and President Obama signed the Patient Protection and Affordable Care Act
and the Health Care and Education Reconciliation Act (ACA), which in part creates health insurance
exchanges. The ACA allows Indian tribes, tribal organizations, and urban Indian organizations to pay
Qualified Health Plan (QHP) premiums on behalf of their tribal members who are enrolled in health
plans in the commercial market, subject to terms and conditions determined by each state exchange
(See 45 CFR 155.240(b)).
In 2012, the Washington Legislature passed Engrossed Second Substitute House Bill 2319, which furthers
implementation of the state-based Washington Health Benefit Exchange (WAHBE). E2SHB 2319 directs
the Exchange Board to establish policies that permit city and county governments, Indian tribes, tribal
organizations, urban Indian organizations, private foundations, and other entities to pay premiums on
behalf of qualified enrollees (See RCW 43.71.030(3)). These entities are known as Sponsors.1
The procedures below describe how Sponsors will be able to pay the unsubsidized2 portion of the
premium for qualified enrollees of a QHP through Washington Healthplanfinder.
Registration Process
Sponsors must complete and submit to the Exchange a form that provides the following information:
 Sponsor contact information
 Conditions of program participation (if any)
 Name(s) and contact information for authorized Sponsor Representatives
o Sponsor Representatives will be able to authorize payment information on behalf of the
Sponsors in the Healthplanfinder.
1
The Exchange is willing to work with any entity interested in paying premiums on behalf of qualified individuals. However,
certain public or nonprofit organizations, or certain public funds, might not be legally authorized to make individual insurance
premium payments. Each entity that would like to be a Sponsor will have to determine whether they have the authority to
spend funds for premium payments.
2 People purchasing a Qualified Health Plan (QHP) through Washington Healthplanfinder may be eligible for government
subsidies (through a tax credit) that can lower the cost of their premiums. Health Insurance Premium Tax Credits (HITPCs) will
be provided to people with a family income between 100% and 400% of the Federal Poverty Level (FPL). The most that these
families buying subsidized coverage in an exchange will pay towards a health insurance premium will range from 2.01% of
income at 100% of poverty to 9.56% of income at 400% of poverty. HITPCs will be paid by the federal government directly to
the insurance issues to lower the cost of premiums.
o
o
Sponsor Representatives will be required to attend a training on managing Sponsorship
payments in Healthplanfinder, complete security training, and complete a background
check.3
In-Person Assisters or Tribal Assisters4 may perform Sponsor Representative functions
upon request of the Sponsor.
Sponsors may cover the premiums for an individual, household, or one or more members in a
household. Sponsors are also allowed to sponsor premiums for any plan they choose. Sponsor
Representatives may inform individuals which plans are sponsored, but when selecting a plan the
individual must be shown all available plan choices. If an individual chooses a plan, tier, or issuer that is
not included in the sponsor’s list of supported plans, the sponsor is not required to sponsor that
enrollee’s premium payment.
Conflict of Interest
If a Sponsor Organization receives any compensation, directly or indirectly, from a health insurance
issuer for enrolling individuals or employees in insurance coverage, then the Sponsor Organization must
disclose that fact to the Exchange and the sponsored individuals at the time of enrollment.
Sponsorship Duration
So that WAHBE may effectively support the sponsorship of household accounts, each entity must
commit to sponsoring an enrollee for no less than 6 months. Exceptions to this durational requirement
based on unexpected events will be considered on a case-by-case basis (e.g., a Sponsor experiences a
sudden financial shortfall).
Note: Each Sponsor may have program eligibility requirements that impact an individual’s continued
eligibility (e.g., only cover individuals up to 300% of FPL). This duration requirement does not apply if the
sponsored individual fails to comply with a Sponsor’s rules of participation.
Copies of Correspondence
Sponsor Representatives, if granted permission by the sponsored enrollee, can receive an electronic
notice each time there is an invoice, correspondence, or update to the enrollee’s Healthplanfinder
account and access these correspondences (See Appendix I for list of enrollee correspondence).5
3
For a Sponsor Representative to provide application and enrollment support, the representative must meet additional training
requirements and pass a qualifying examination.
4 To become an authorized representative for a sponsoring organization, an in-person or tribal assister would complete an
additional sponsorship-specific training module(s).
5 Sponsorship representatives who will be ‘linking’ to individual accounts will need to sign an agreement that indicates that
individual account information will not be shared or misused. A Sponsorship Representative is distinct from an “Authorized
Representative.”
All policy notifications from the health insurance issuer will be sent directly to the individual enrolled
with the issuer. Sponsored individuals will also be billed directly for any out of pocket costs, such as copays or deductibles, or their share of covered services provided.
Payment Requirements
Premium payment(s) will be made by Sponsors directly to Healthplanfinder on behalf of the sponsored
enrollee(s). To complete the initial enrollment for sponsored enrollees, the Sponsor representative will
need to initiate payment on their behalf.
For the initial payment the Exchange will accept credit cards, debit cards, or e-checks.6 No transaction
fees will be incurred for electronic payments. Sponsor account or credit card information will not be
viewable by the sponsored individual.
Sponsors must cover the entire premium payment after any eligible health insurance premium tax credit
has been applied.7 No partial premium payments are allowed. The sponsor must pay the full invoice
amount (for all household members seeking coverage through a single application). For example, if
three members in a family enroll together in a qualified health plan, the sponsor would need to cover all
enrollees in that household. If a sponsor only wants to sponsor one member of a household, this
household member will need complete a separate application seeking coverage only for him/herself.
Sponsor payment information must be entered for each QHP enrollment household or individual that is
being sponsored. This information can be entered by a Sponsor Representative who is with the
sponsored enrollee or at a different off-site location, if the sponsored enrollee has granted permission
for the Sponsor Representative to access his/her account.8
A Sponsorship Representative can set up a monthly recurring electronic payment for each sponsored
enrollee, so the Sponsor account information only needs to be entered once. Recurring payments are
processed each month on the date designated by the Sponsorship Representative. Recurring Payments
can only be made using the eCheck option (savings or checking account), after the initial payment has
been posted. If the recurring payment is set up before 5pm it will take effect the following business day.
A Sponsor is always able to remove their sponsorship, by deleting payment information or no longer
providing it. The Sponsor is responsible for notifying individuals who are being removed at least 15
business days before the next payment is due.
6
After an initial electronic payment, paper checks/money orders/cashier’s checks with Remittance Coupons will also be
accepted. QHP enrollees may also pay their premium contribution directly to their QHP issuer.
7 Sponsor organizations may want to consider requiring individuals to apply the maximum amount of HIPTC to their monthly
premium. In Healthplanfinder, if an individual is determined to be eligible for a tax credit he/she then selects how much of the
subsidy to apply towards their premium amount each month.
8 Sponsorship representatives who will be ‘partnering’ to individual accounts will need to sign an agreement that account
information will not be shared or misused.
Payment Process
9

Open enrollment period begins November 15, 2014 and extends through February 15, 2015. 9
Enrollment Completed
Coverage Effective Date
On or before December 23, 2014
January 1, 2015
January 1-23, 2015
February 1, 2015
February 1-15, 2015
March 1, 2015

Initial payment is entered in the Healthplanfinder by the Sponsor Representative. This payment
amount will be in the amount of the first month's premium payment. For the initial payment,
the Sponsorship Representative will choose a date between 12/1/14 and 12/23/14 when the
initial premium payment will be withdrawn.

Sponsor Representatives can also set up recurring payments. Recurring payments are processed
each month on the date designated by the Sponsor Representatives. An email address is
required to set up recurring payments. Recurring payments can only be made using the eCheck
option after the initial payment has been posted.

After coverage begins, invoices will be sent to enrollees on the 1st of the month based on their
selected communication preference (electronic or postal mail). For example, an invoice will be
sent on March 1st for the April 1st-30th coverage period. The individual payment is due by the
23rd of each month (March 23 in this example).

The Exchange will generate a receipt when a premium payment is made through
Healthplanfinder.

Key Bank will be responsible for processing payments and sending electronic payments to
issuers on behalf of covered individuals.

A sponsored enrollee is responsible to ensure their premium payment was successfully made. If
a premium payment is not made on behalf of the sponsored enrollee, delinquency, grace period
and termination could occur. In these cases the enrollee must submit premium payment to the
Exchange to be removed from delinquency status.
o If payment is not received or is invalid due to insufficient funds, the Exchange will send a
delinquency notice to the enrollee on the 1st of the month in which a payment for that
month was not received.
o Households that are receiving Health Insurance Premium Tax Credits are eligible for a 3month grace period to make payments, beginning on the 1st of the month following a
missed payment.10 If a payment is not made during the 90 day grace period, coverage
will terminate effective the last day of the first month in the grace period.
American Indians and Alaska Natives (AI/ANs) are not subject to open enrollment restrictions and may enroll in the Exchange
at any time during the year. Individuals with Special Enrollment Periods (SEPs) may also enroll after open-enrollment ends.
10 Qualified Health Plan (QHP) households not receiving HIPTC have a 1-month grace period. If payment is not made during the
30 day grace period, they will be disenrolled effective the last day of the month prior to their grace period. For example, if an
enrollee fails to make payment for the coverage period of April 1- April 30, coverage will terminate effective March 31.
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For example, enrollee fails to make payment by March 23rd for the coverage
period of April 1- April 30. If no payment is made during their April 1 – June 30
grace period, coverage will terminate effective April 30.
The QHP issuer is required to pay claims during the first month of a grace
period, but may suspend claims in the second and third months.
Exchange Services Related to Premium Sponsorship
For the individual market, the Exchange will aggregate the premium contributions of QHP enrollees, and
transmit those aggregated premium payments to the appropriate issuer. The federal government will
coordinate payments of the HIPTC (and cost-sharing reductions) directly with the issuers.
The Exchange will provide staff to manage the sponsorship process, provide training for Sponsor
Representatives, and grant access so Representatives can initiate payment on behalf of the sponsored
individuals.
As needed, the Exchange will also generate periodic reports to assist Sponsors with budgeting and
future planning.
Sponsorship Timeline for 2015 Coverage Year
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11
September—WAHBE hosts a Premium Sponsorship webinar with Sponsors
October—Sponsors identify authorized Sponsorship Representatives who are not also Tribal
Assisters, Navigators, Certified Application Counselors (CAC), or In-Person Assisters (IPA)
September—Tribal Assisters, Navigators, Certified Application Counselors (CAC), or In-Person
Assisters (IPA) receive training
October—Sponsorship Representatives receive training
Fall—Sponsors conduct outreach to sponsored individuals
Nov 15-Dec 23—Enroll sponsored individuals for coverage effective January 1, 2014
February 15, 2015—Open enrollment ends11
American Indians and Alaska Natives (AI/ANs) are not subject to open enrollment restrictions and may enroll in the Exchange
any time during the year. Individuals with Special Enrollment Periods (SEPs) may also enroll after open-enrollment ends.
Appendix I: QHP Enrollee Correspondence
Below is a list of enrollee correspondence that the Exchange will be responsible for sending:

Eligibility Decision for Health Care Coverage notice: The Exchange will send individuals an
eligibility determination notice that specifies what programs the primary applicant and the
other members of the household are eligible for including Medicaid, Apple Health for Kids,
APTC, or QHP.

Monthly Invoice: The Exchange will invoice enrollees in the individual market on the 1st of the
month prior to the month of coverage.

Receipt of Payment: The Exchange will generate a receipt of payment for individuals when
enrollees make a premium payment through the Exchange.

Premium Payment Delinquency notice: The Exchange will send a delinquency notice to the
enrollee on the 1st of the month in which a payment for that month was not received.

Health Benefit Termination notice: In a disenrollment scenario, the Exchange will send the
enrollee a Health Benefit Termination notice which states the day that their coverage in an
Exchange QHP will end or did end if retroactively disenrolled.

Yearly Advance Premium Tax Credit Summary notice: The Exchange will provide enrollees who
are eligible for APTC a yearly notice that summarizes the amount of APTC they received for the
previous tax year.

Upcoming Open Enrollment Deadline notice: During Open Enrollment the enrollee will receive
an Upcoming Open Enrollment Deadline notice which states the beginning and end date for
Open Enrollment and prompts the enrollee to select and enroll in a Plan for the next coverage
period. This correspondence will not be sent during the initial open enrollment period.

Upcoming Special Enrollment Deadline notice: If an enrollee is eligible for a Special Enrollment
Period and has not selected a plan, the Exchange will send the enrollee an Upcoming Special
Enrollment Deadline notice to prompt them to return to the Exchange to select and enroll in a
plan. This notice also explains to the enrollee that if they do not update their plan selection they
may be disenrolled from coverage.