Cash in Lieu (CIL)

Cash-in-Lieu (CIL) is offered to our members versus having the contractor assigned to the member’s claim to complete the repair or replacement. This could be at the member’s request or AHS initiated based on circumstances surrounding the member’s contract.

Since a diagnosis is needed in order to make either a repair or replacement, authorizers should include labor-to-date (LTD) for the contractor’s diagnosis when determining the Cash-in-Lieu (CIL) offer to the member.

When calculating a CIL, Autho associates will deduct LTD from the limit along with any repairs that have already been made from current or past work orders placed.

CIL will be sent to the member when the contract item limit is exceeded Proof of repair

Cash-in-Lieu (CIL) checklist

CA member calls in to accept CIL

Member calls to check the status of P/O/R

Proof of Repair (Update: 9/13/2021)

Proof of repair is needed prior to the CIL being sent to the member for HVAC and Appliances only.

Proof of Repair is not required prior to the CIL being sent for Plumbing (this includes Water Heaters), Electrical, Pool & Spa, or other minor trades. CIL check will be processed without receiving P/O/R first. However, the item will remain excluded from coverage until P/O/R is received and documentation is accepted.**

** Some Shield plans do not require proof of repair prior to the CIL being sent, regardless of the trade. Agents must review contract for confirmation.

** CIL check for members in California will be sent prior to AHS receiving proof of repair, regardless of the trade.

NOTE: If a member requests a CIL email, you would email ahscil@ahs.com to request an email be sent to the member.

Prior To Offering A CIL

Prior to offering a CIL to a member, the associate should:

• Review status of the member’s contract prior to calculating the CIL looking for:

• Active term dates (ensure the contract is not canceled) Contractor’s diagnosis of the system/appliance comparing to contract coverage
• Limit amount
• Any other work orders placed on the limit item to decide if any amounts should be deducted from the limit

• Determine limit balance (if applicable) for contract year by reviewing contract history.

• Determine the status of the member’s service fee payment due to AHS.

                           * Service Fee Paid
  

If the service fee was paid, then do not deduct it from the CIL offer.

             * Service Fee Not Paid and Limit Does Not Apply

If the service fee was not paid and limit does not apply, then deduct the service fee amount from the CIL offer .

                       * Service Fee Paid and Limit Does Apply

• If the service fee was paid and a limit applies, then add the service fee to the limit amount.

Example: $1000 limit and service fee of $75 paid. Determine CIL by adding the limit amount of $1000 plus $75 for a total of $1075. Then, deduct LTD and any repairs.

Service Fee Not Due

If the service fee is not due (recall, transfer, etc.), then start the CIL calculation with the limit amount then deduct any repairs and LTD.

Example: $1000 limit minus repairs and LTD. (The service fee is not deducted since it was not due.)

1. Determine LTD plus any repairs/replacements already made.

Unless otherwise noted in the estimate authorization screen authorize the contractor one hour of labor based on their vendor rates on the contractor details section. From that point, the contractor will not be able to bill out more than what has been authorized without approval from Contractor Relations. 5. Calculate the CIL amount.

                                      Offering a CIL

Call the member to make the offer.

Answering Machine Reached

If you reach the member, then leave a message for the member to call the Authorizations department back directly.

Leave department phone number to contact, but do not provide the CIL amount to the member on voicemail.

Member Reached

If the member is reached, then:

Offer member the CIL. Advise member: Proof of repair is needed and must be for repair/replacement based on the diagnosis provided by the technician. They will need to submit a copy of the paid receipt showing the purchase and installation from a licensed/insured technician if they wish to have future coverage on the item. They may send this to ahspor@ahs.com. Who the check will be made out to What address the check will be sent to That he/she should receive a check within 7-10 business days After processing the CIL through the Cash-in-Lieu Calculator, update contract exclusions.

If a contract limit applies add the remaining CIL amount to any limits where repairs/diagnosis is deducted.

Cash-in-Lieu (CIL) Checklist

Follow the steps below to help ensure Cash-in-Lieu (CIL) is calculated and documented in the system correctly.

Verify Labor-to-Date (LTD) and Service Fee (S/F) status.

Unless otherwise noted in the estimate authorization screen, authorize the contractor one hour of LTD based on applicable vendor rates in the contractor details section. From that point, the contractor will not be able to bill out more than what has been authorized without approval from Contractor Relations.

If tech has not billed out

Document LTD and S/F status if not already documented in the Estimate Authorization screen.

If tech is on Monthly Average Cost (MAC) rate

Authorize tech 1 hour of LTD for the item that is being cashed out or actual LTD, if noted in the Estimate Authorization Screen.

Review the detailed diagnosis. If Item has limit

Ensure no other service calls have been placed on the item during the current contract year.

If a service call has been placed on a limit item

Deduct from limit amount when calculating CIL.

Check equipment status. Cancel equipment requests as needed. Verify if tech provided equipment and if any return/delivery charges were incurred. If equipment is shipped to shop and over 90 days since order shipped

Do not calculate CIL as this is not an option.

If equipment is shipped to shop and less than 90 days since order shipped

The unit may be able to be returned but with reshipping and restocking fees from the tech. Proceed with CIL offer deducting any shipping/restocking fees as applicable. If equipment is picked up

The unit may be able to be returned but with reshipping and restocking fees from the tech. Proceed with CIL offer deducting any shipping/restocking fees as applicable. If the member chooses repairs/replacement

• Call contractor to verify type/size of equipment needed.
• Notify the Purchasing Dept. to order parts/equipment (if not yet ordered).

If the member has received the CIL check. has not cashed it and has decided that he/she would rather go with the repair/replacement

Submit a Check Research form to have a stop payment placed on the check. Once Accounting confirms that it was not cashed, the agent can ensure that the tech is authorized correctly for the repair/replacement and notify them to proceed with the repair/replacement. (See also: Check Research) If member accepts CIL and the work order is already authorized

Cancel the autho decision Repair Estimate and authorize LTD only.

Enter Proof of Repair (P/O/R) Needed note for future coverage

If member accepts CIL and the work order is not already authorized

Enter Proof of Repair (P/O/R) Needed note for future coverage.

                        Offering CIL to California Members

• When offering a CIL to a member in the state of California, it is important that the offer is made through the CIL calculator in CSC (or STAR) so a CIL Offer line is generated in the authorization screen. This authorization decision feeds the automated CA CIL follow up process.

• You must inform the member of the following when making the offer, as the CIL team will process the CIL after 21 days from the offer to be in line with CA DOI requirements:

Sample Verbiage: “So that we may complete this process for you in a timely manner, please respond to us with a decision or update us that you need more time to make a decision within 21 days. If we do not hear from you within this timeframe, we will move forward with processing the reimbursement to you for the amount offered.”

                     California Member  Accepts CIL

         Authorizers will process the CIL acceptance via the CIL Calculator.

• Enter Proof of Repair (P/O/R) Needed Note

• CIL check will be processed without receiving P/O/R first. However, the item will remain excluded from coverage until P/O/R is received and documentation is accepted. Member Calls to Check Status of P/O/R

• Confirm the email the member sent the P/O/R to; it should be ahspor@ahs.com.

• If the P/O/R was emailed to the proper email address, verify if the member received an auto-response indicating AHS received their email. If they did not, AHS did not receive it and the member will need to resend it. If they did, notify the member that the P/O/R will be worked in the order received.

• Review CIL status email to confirm the date that the P/O/R team is currently processing.

                                           COMMON CALL OUT 
  

• MEMBERS GIVING AMOUNT - WHO CAN

• PROVIDE THE AMOUNT? CASH OUT DEPARTMENT.

not allowed to offer cash out- we need to submiy