Late payment grace period
If we don't receive and post your premium payment on or before the first day of the month when the premium is due, your coverage doesn't end immediately. You're protected by a "grace period" - extra time in which to send us your late premium.
Eligible for the Advance Premium Tax Credit (APTC) = Three-month grace period
If you miss paying your monthly premium, your health coverage will continue for 90 days.
If you don't catch up paying your premium(s) during your grace period:
- Your coverage will end as of midnight on the last day of your first month of grace period.
- You will owe us for all costs of covered services you received that we paid for during the second and third months of the grace period, and we can collect those costs plus the costs of recovering these charges.
- You will not be eligible to enroll for health coverage again until the next Open Enrollment Period.
What happens with claims filed during your grace period
- During the first month, we will pay claims normally.
- During the second and third months, claims will be pended. That means the claims will be held by us and will not be paid or denied.
- After three consecutive months without payment in full, the member is retroactively termed and we deny any claims that were pending, beginning with month two, indicating the member is not eligible. The member would then be responsible for the charges and will receive bills from the doctors.
NOT eligible for the Advance Premium Tax Credit (APTC) = 30-day grace period
If you miss paying your monthly premium, your health coverage will continue for 30 days.
If you don't catch up paying your premium(s) during your grace period:
- Your coverage will end as of the end of the last premium period for which we received your payment.
- We can collect from you all costs of covered services you received and we paid for during the grace period, plus the costs of recovering these charges (including attorney's fees).