Mid-month Member Premium Calculation Rule Change For Oxford 2.0 New Jersey New and Renewing Groups
Posted on July 28, 2020
Correction On Mid-Month Member Premium Calculation Rule Regarding New Jersey Large Groups
Oxford has advised that they need to correct their initial communication to us. The new mid-month calculation rule DOES NOT APPLY TO NEW JERSEY LARGE GROUPS. Large Groups will continue to use the current mid-month calculation rule and only New Jersey Small Groups will use the new rule communicated below in our original email notification.
Mid-month Member Premium Calculation Rule Change For Oxford 2.0 New Jersey New and Renewing Groups
Oxford has advised that for new business going forward and upon renewal NJ Groups (both small and large *correction: does not include large groups*) there has been a change to how the premium is calculated for members that are added or termed mid-month. The new mid-month rule is a Daily Pro-Rate of the first month’s premium based on the Enrollment Effective date, and the last month’s Termination Date calculated as follows:
Monthly premium divided by number of days in that month times number of days member is enrolled that month
Note: All other lines of business will remain on the current mid-month rule shown below for reference.
- A member is charged a full month’s premium if he or she is on the plan for the majority of the month:
- Members enrolled on or before the 15th of the month
- Members terminated on or after the 16th of the month
- A member is not charged for a month in which he or she was not on the plan for the majority of the month:
- Members enrolled on or after the 16th of the month
- Members terminated on or before the 15th of the month
