Employees leave jobs. When one leaves an employer client, you need to know three things: the date the employer stops paying, what happens to the member and their family, and how the change reaches your invoice. Write the rules into the contract, then follow the same steps every time.
When billing stops
Pick one rule and use it for every employer. One option is that billing stops at the end of the month the employee leaves. Some contracts stop billing on the last day worked, with a partial month. A whole-month rule is easier to bill and easier to explain.
What happens to the member
Check what the contract says about a member who leaves the employer. Offer them a way to stay as an individual member at your regular price.
- Send a short note explaining their options and the date their employer coverage ends.
- Give them a simple way to sign up as an individual member.
- Don't charge their card until they agree to it.
Dependents
Check whether dependents leave with the employee. Offer them the same individual option.
How you find out
The employer should tell you through the monthly census. Compare each new census with the last one, and ask about anyone missing. This post covers matching the census to your billing.
When you find out late
If you learn three months later that someone left, the employer may ask for a credit. Your contract should say how far back changes can go. Here's how to handle retro changes.
In a made-up example, an employee left in March, the employer told you in June, and the contract allows retro changes for the current and prior month only. Billing should have stopped after March. You credit May and June at $70 each, $140. April falls outside the window, so it stays billed.
Continuation rules
Whether a departing employee has a right to keep employer-sponsored coverage under continuation rules is a question for the employer's advisors, not you. Include it in the questions you hand them.
What I'd do this week
- Check each contract for when billing stops after a departure.
- Write a short template note for departing members.
- Compare this month's census with last month's for anyone missing.
Common questions
Can I keep billing the employer until they tell me?
Bill according to the contract. If it allows retro credits, expect some, and make sure the window is written down.
Should a departing member get a discount to stay?
You could waive the enrollment fee. Keep the monthly price the same as other individual members.
What if the member was in the middle of care?
Clinical decisions come first. Talk to the member about their options before their coverage ends.
Want every employer change reflected on the next invoice?
We reconcile every account every month and send your P&L and Balance Sheet by the 15th, so decisions like this start from real numbers. If that's what you need, apply to work with us.