Invoicing
Invoices are generated on the 25th and funds are pulled on the 1st.
Exceptions to invoice dates are only granted in unique situations. Yuzu’s payments team reviews exception requests on a case-by-case basis.
The invoice for the final month of the plan year will generate on the 1st of the month.
This invoice will be based on the eligibility data on file at the time of invoicing, inclusive of any members with pending coverage effective within that final month.
No invoice will be issued after the final month of the plan year, including “post-close” invoices used to reconcile eligibility adjustments following the final invoice.
Clients are responsible for ensuring that all eligibility data is accurate prior to the generation of the final month invoice.
Any eligibility changes that come after an invoice has been generated will not show up on that month’s invoice and will be automatically reconciled on the next month’s invoice.
Groups must have a bank account on file so Yuzu can withdraw each month’s invoice and distribute payments to vendors.
If a payment fails or is reversed, Yuzu will notify the Plan Designer so the group can update their banking details or resolve the issue promptly.
If the group continues to fail to make the monthly payment, all claims processing and outgoing payments will be suspended until the outstanding balance is paid.
If the issue remains unresolved, Yuzu reserves the right to terminate the group per the Administrative Services Agreement.
Plan Switches
There is a 30 day window to correct inaccurate member plan election. After the initial 30 days, Yuzu assumes all members were assigned to their accurate plan election and will adjudicate claims accordingly.
Members may also switch plan selections during special enrollment periods. For unique situations, Yuzu’s Account Management team reviews requests on a case-by-case basis.
Waiting Periods, Employee Termination, and Child Age-Out Rules
Groups may switch waiting period language up until the end of the first 30 days of the plan.
If the waiting period language is changed after the plan start date, Yuzu will require evidence of approval from the group’s stop loss vendor.
Yuzu does not permit waiting period changes after the first 30 days of the plan year without the issuing of a Summary of Material Modifications (SMM). In the case of a late waiting period change, the employer, broker, or plan designer is responsible for issuing the SMM to all group members.
The above policies also apply to changes in employee termination and child age-out termination rules.
Vendor Changes
Any vendor changes after a group’s start date will require an updated SPD and may require approval from stop loss.
COBRA vendors cannot be changed from Yuzu-managed → external once a member has already elected Yuzu COBRA.
Eligibility Maintenance
The employer/broker must keep track of eligibility changes and update the portal accordingly. Yuzu is the source of truth for eligibility information for payment purposes but it is up to the employer/broker to notify Yuzu of changes.
The employer/broker must notify Yuzu of census issues/changes within 30 days of the change.