Grace Period Requirements for Individuals Receiving Financial Assistance
The health care law requires that Marketplace members who purchased a plan through Healthcare.gov and received advance premium tax credits be given a three-month grace period to make premium payments. During this time, health insurers may not dis-enroll members. And, during the second and third months of the grace period, insurers are also required to notify health care providers about the possibility that claims may be denied if the premium is not paid.
It is important to note:
- The extended grace period ONLY APPLIES to Marketplace members who receive financial assistance. The 31-day grace period applies for all other individual members.
- Individuals must pay their first month’s premium before coverage is effective. The first month’s premium is due 30 calendar days from the effective date. Coverage will cancel if the premium is not paid in full. Additionally, coverage must be in effect before the member is sent an ID card.
- The grace period only applies after the member has made an initial premium payment to start their coverage.
- BlueCross will pay for claims processed during the first month of the extended grace period.
- BlueCross will not recoup payments made to providers during the first month of the extended grace period.
BlueCross will use multiple ways to communicate with you when a member is in the grace period.
- After the first month of non-payment, the member is identified in our system as being in the grace period.
- When verifying eligibility through Availity®, you will see a notification that reads “Member in Grace Period – Pended Due to Non-Payment of Premium.”
- Our provider phone service team will inform you the member is in the grace period when you call us to verify eligibility.
- We will send you a letter, which is generated when you file a claim.
- We will include a notification on your remittance advice.
In addition, it’s important to know we are also reaching out to members who are in the grace period. We encourage them to make premium payments and educate them on the financial risks they take by not keeping current on payments.