Premium Administration
Click on the links below or scroll down to find instructions about specific situations.
Billing
Grace Period
Returned Checks
Sample Billing & Premium Reporting Cycle
Participating Sponsor's Fiduciary Reponsibility
Changes in Coverage
Billing
Pioneer Management System will issue a monthly or quarterly (as selected by the employer) billing statement. The employer should pay as billed. Changes should be noted by the employer on the remittance. Pioneer Management System will make the necessary adjustments on the following billing statement. An administrative fee of up to $9 depending on group size will be included on each billing statement. The fee amount shown on the billing statement, including the administrative fee, must be paid by the 1st of the month.
The first premium due date will be the Employer's effective date. Subsequent premiums are due the first day of each succeeding month (or otherwise agreed upon billing mode). Premiums are to be received on or before the due date.
When Pioneer Management System Bills,
Pioneer Management System will prepare initial and ongoing bills. Bills will be mailed/e-mailed on the 10th of the preceding month and payable by the 1st of the following month. Premium should be remitted as billed; adjustments will be reflected on the next bill.
Top
Grace Period
A 31-day Grace Period will be allowed for receiving premium.
If premium is not received by the 31st day, a lapse letter will be sent and where possible, via e-mail to either the Employer or the individual indicating that the coverage has been terminated.
Top
Returned Checks
In the event that a check is returned because of insufficient funds, an additional service fee of $29.00 will be added to the premium bill. Pioneer Management System will notify the Employer by fax that a certified or cashier's check for the premium due plus the $29.00 service fee is required to keep coverage in force. This check must be sent by overnight courier to Pioneer Management System.
Top
Sample Billing & Premium Reporting Cycle
The following is an example of the billing and premium reporting cycle and timeframes. This example assumes an original effective date for September 1:
| Action |
Date |
| Bill for September 1 released by Pioneer Management System |
August 10 |
| Premium Due Date |
September 1 |
|
Bill for October 1 released by Pioneer Management System (will include any changes, adjustments, and / or balance forward) |
September 10 |
| Pioneer Management System releases Lapse Notice indicating termination of coverage for non-payment of premium |
October 1 |
Top
Participating Sponsor's Fiduciary Responsibility
The Employer has the fiduciary responsibility of paying premiums on behalf of its employees/members including, but not limited to, where payroll deduction is a method of payment.
As indicated in the Sample Billing and Premium Reporting Cycle example, the Employer will be notified when prompt payment has not been received. Such notice will indicate the consequences of non-payment. It is the Employer's responsibility to advise each insured individual of the termination of coverage when payment is not made in a timely manner.
Top
Changes in Coverage
Changes may occur that will affect the coverage for employees insured under the plan. Some will be initiated by the employee; others will be initiated directly by the Employer. The following changes must be reported monthly to Pioneer Management System:
- Addition of new employees - submit a completed enrollment form.
- Termination of employment of employee becomes ineligible for insurance due to age, in an uninsured class, or where he/she no longer qualifies as eligible under the defined Eligibility section of the Group Policy.
- Death of the employee.
- Termination of coverage at the request of the employee.
- Termination of dependent coverage in the event:
a. An insured dependent dies.
b. An insured dependent child reaches limiting age, marries and/or is no longer eligible.
c. An insured spouse is no longer a "lawful spouse."
NOTE: For items 2-5 above, refer to the Can Coverage Continue After Termination? information in the Administration Section to determine if the employee/dependent should be given notice of the Continuation options available.
You may also want to refer to the " How and When Should Changes in an Employee's or Dependent's Coverage Be Reported?" information in the Administration Section regarding other changes that may not affect premium remittance.
Top