If a consumer makes a QHP change to a different QHP issuer before the coverage effective date, but after making their initial binder payment, which issuer is responsible for refunding the January premium?

If a consumer makes a QHP change to a different QHP issuer before the coverage effective date, but after making their initial binder payment, which issuer is responsible for refunding the January premium?

• A. The initial QHP issuer
• B. The new QHP issuer
• C. CMS
• D. The consumer

Answer: (A)

The main idea is that premium payments are tied to the QHP issuer you were originally enrolled with, and refunds are handled by that issuer if the coverage never actually starts due to a change before the coverage date. If a consumer switches to a different QHP issuer before the coverage effective date but after paying the January premium, the initial QHP issuer must refund that January premium because the plan they issued never became active. The new issuer will bill for the new plan starting on the coverage effective date. CMS doesn’t issue refunds to consumers in this scenario, and the consumer isn’t responsible for refunding themselves. The binder payment is intended to secure the initial plan, and when that plan doesn’t go into effect, the refund of the January premium rests with the initial issuer.

The main idea is that premium payments are tied to the QHP issuer you were originally enrolled with, and refunds are handled by that issuer if the coverage never actually starts due to a change before the coverage date. If a consumer switches to a different QHP issuer before the coverage effective date but after paying the January premium, the initial QHP issuer must refund that January premium because the plan they issued never became active. The new issuer will bill for the new plan starting on the coverage effective date. CMS doesn’t issue refunds to consumers in this scenario, and the consumer isn’t responsible for refunding themselves. The binder payment is intended to secure the initial plan, and when that plan doesn’t go into effect, the refund of the January premium rests with the initial issuer.