Claims Payment Information

COORDINATION OF BENEFITS (COB)

MHP does not pay a claim when it is unclear as to whether MHP is the primary or secondary payer. We recommend that you always ask patients when they register if they have coverage from more than one insurance carrier or if their injury is the result of an accident.

When MHP is secondary, be sure to submit a copy of the primary carrier’s Explanation of Benefits (EOB) along with your claim and indicate in the “Remarks” section that an EOB is attached.

COB claims should be submitted on paper since the EOB received from the primary payer must accompany the claim. COB claims must be submitted to MHP within twelve (12) months from the date of service or 90 days from the date of the primary payers EOB.

Submit all claims to:

McLaren Health Plan
PO Box 1511 Flint,
MI 48501-1511

FAILURE TO PAY INITIAL PREMIUM

Whether you purchase your MHP Community individual coverage on or off the Michigan Marketplace, your enrollment is not complete until you have paid your first month’s premium.  This is referred to as your “Initial Premium”. It must be paid directly to MHP Community – not to the Michigan Marketplace.  This payment must be paid no later than 30 calendar days from the intended effective date of coverage in order for your coverage to begin.

You will usually not have a payment coupon booklet before your Initial Premium is due, so please do one of the following:

  • Call Customer Service at (888) 327-0671 for instructions on how to pay your Initial Premium;
  • Hand deliver your Initial Premium to the McLaren Health Plan Community office at G-3245 Beecher Road, Flint, Michigan; or
  • Mail your Initial Premium to P.O.Box 771983, Detroit, MI 48277-1983

If we do not receive your payment within the 30-day time period your coverage will not be effective.

TERMINATION OF COVERAGE

TERMINATION FOR NONPAYMENT OF PREMIUM

If the Subscriber fails to pay any premium other than the Initial Premium – whether in whole or in part, by the due date - the contract is in default.

A.  MEMBERS WHO RECEIVE ADVANCED PREMIUM TAX CREDITS (APTC):

If you purchased your Coverage on the Michigan Marketplace and receive APTC and you have paid at least one full month of premium during the current benefit year, you will be given a three (3) month grace period during which the premiums must be brought up to date. If you need health care services at any time during the second and third months of the grace period, MHP Community will hold payment for claims beginning on the first day of the second month of the grace period and notify the Participating Provider that we are not paying these claims during this time.  If premiums are not brought up to date within the three month grace period, your Coverage will be cancelled.  Your last day of Coverage will be the last day of the first month of the three-month grace period. All claims for any health services that were provided after the last day of Coverage will be denied, and any Benefits incurred by a Member and paid by MHP Community after the Termination effective date may be charged to the Subscriber or the Member who received the Benefit.

B.  MEMBERS WHO DO NOT RECEIVE ADVANCED PREMIUM TAX CREDITS (APTC):

If you purchased your Coverage on or off the Michigan Marketplace, you do not receive APTC and you have paid at least one full month of premium during the current benefit year, a grace period of 31 days will be granted for the payment of each premium falling due after the first premium, during which grace period the policy shall continue in force.  If premiums are not brought up to date within the one month grace period, your Coverage will be cancelled.  Your last day of Coverage will be the last day of the last month in which a full monthly premium was received by MHP Community.  All claims for any health services that were provided after the last day of Coverage will be denied, and any Benefits incurred by a Member and paid by MHP Community after the Termination effective date may be charged to the Subscriber or the Member who received the Benefit. 

C.  TERMINATION OR NON-RENEWAL OF A MEMBER’S COVERAGE – ADDITIONAL CAUSES

Coverage for a Member may also be Terminated or Non-Renewed for any of the reasons listed below.  Such Termination or MHP Community’s decision to Non-Renew Coverage is subject to thirty days’ notice (including the reason for the Termination or Non-Renewal) and, if applicable, grievance rights, and is effective on the date specified by MHP Community or the Michigan Marketplace.

  • The Member enrolled in a Michigan Marketplace plan is no longer eligible for Coverage through the Michigan Marketplace;
  • The Member enrolledwith MHP Community off the Michigan Marketplace no longer meets MHP Community eligibility requirements;
  • The MHP Community Michigan Marketplace plan is terminated or decertified by state or federal regulators;
  • The MHP Community plan is withdrawn from the marketplace by MHP Community in accordance with state and federal laws;
  • A contract is cancelled for nonpayment of premium;
  • The Member changes products;
  • The Member moves out of the MHP Community Service Area;
  • The Member enrolled with MHP Community off the Michigan Marketplace ceases to be a member of an association through which the Member has achieved eligibility; or
  • The Member commits fraud against MHP Community or a provider of Benefits.

A Member wishing to Terminate Coverage must provide at least fourteen (14) days’ notice to MHP Community or the Michigan Marketplace (as applicable) of his or her wish to Terminate.

D.  RESCISSION OF MEMBER’S COVERAGE

Rescission of Coverage means the Member’s Coverage ends retroactive to the date a Member committed fraud against MHP Community or a provider of Benefits, or intentionally misstated or intentionally withheld a material fact. MHP Community will provide at least 30 days’ notice of a rescission. A Member may appeal a Rescission of Coverage by following the MHP Community Complaint and Appeals Procedure. Fraud or intentional misstatement or withholding of a material fact includes:

  • Intentional misrepresentation of the eligibility of a Member;
  • Fraudulent use of the MHP Community ID card; or
  • Fraudulent use of the MHP Community system.

NOTE:  Any amounts paid by MHP Community after the event are due and owing from the Member.

For retroactive denials, recoupment of overpayments and/or any other information regarding claims, please contact Customer Service at (888) 327-0671.