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worker.

C. Premium Invoices for Application/Recertification/Change in Circumstance

1. Application process:

a. Prepare the DHB-5146, Health Coverage for Workers with Disabilities Premium Notice and ensure all premiums due from the first month authorized through one month after the current calendar month are included.

b. If 12 calendar days exceed the 45/90-day processing standard, do not dispose of the application until notice of payment has been received, or until the first workday after the due date for payment, whichever is earliest.

c. Allow for the exclusion of application processing days, when necessary, verifications are received and the only remaining item necessary to process the application is the premium (and enrollment fee when applicable).

d. The exclusion of days begins on the day of the request for premium payment and ends on the day the premium is received or on the 13th calendar day, whichever occurs first.

Refer to NC FAST Job Aid: Stop Processing Time.

Note: If pending for enrollment fee and premium(s), the end date is the later of the dates the enrollment fee or premium(s) is received. Continue to exclude days until both payments are received.

2. Retroactive Months

An applicant who requests retroactive coverage must pay a premium for each retroactive month authorized. An a/b cannot choose the month to which the premium is to be applied.

Note: No enrollment fee is due for retroactive months.

3. Recertification or Change of Circumstance ongoing cases:

a. Send the DHB-5146, Health Coverage for Workers with Disabilities Premium Notice on the first business day of the month prior to the next month of eligibility.

b. Allow the beneficiary 12 calendar days to pay the premium; day one is the day after the invoice is mailed.

Docusign Envelope ID: B8C63DC7-7367-4210-853E-B7B004802EE4