TN 49 (11-22)

HI 01001.230 Group Collection-General

It is not necessary that the enrollee who is being billed pay their premiums themselves. They may be paid by the enrollee, a relative, friend, organization or by anyone else. An organization, employer, or other source may pay premiums on behalf of one or many enrollees. However, the premiums must be paid timely if SMI coverage is to continue, and payment must be in a form which permits expeditious and economical handling (e.g., with the billing notices attached, so that the payment can be identified readily with the appropriate enrollee).

However, there will be cases in which the paying organization wants to be billed on behalf of a number of enrollees, since it will be inconvenient or impossible for the organization to obtain from each of several hundred or thousand enrollees the individual billing notice in time to make a single payment for the group. Where bills are sent directly to such an organization the payer must meet the requirements in HI 01001.240. It will defeat the purposes of group billing if the group payer and the enrollee are billed simultaneously since the premium might be paid by both the enrollee and the group, or by neither.

Group billing for payment of premiums will be made only under conditions which protect the rights of the enrollee and only so long as these conditions are met by the “payer” organization. Group billing will not be permitted if the enrollees in the group must pay any costs for such premium collection. The group billing arrangement is intended primarily to apply in cases where funds other than the enrollee"s are used to pay at least a substantial part of the premiums or where the group payer deducts the premiums from periodic payments it makes to the enrollees in the group. Any inquiry from a potential group payer should be directed to the CMS, BPO, OMS Division of Eligibility Systems, Baltimore, Maryland, 21207.