Grace Periods under Health Care Reform are a REAL problem!!!
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The Grace period under Heatlh Care Reform is:
Grace period for recipients of advance payments of the premium tax credit.
A QHP Qualified Health Plan issuer must provide a grace period of three consecutive months if an enrollee receiving advance payments of the premium tax credit has previously paid at least one full month’s premium during the benefit year. 45 CFR 156.270 (d)
Once a member is terminated for non-payment, they cannot be reinstated.
In the past, as an agent, we would get late notices, now we don’t or rarely do. So, read up, email us and let’s see what we can do to keep coverage in force for when you need it and avoid tax penalties, bankruptcy or not getting the medical treatment you need – 10 essential benefits.
Health Care.Gov on Grace Periods
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Here are excerpts various bulletins we’ve received about Grace Periods under Health Care Reform
New Payments (Covered CA) can be made here.
Policies cancelled for NO reason or explanation Learn More ==> CA Health Line 3.22.2016
Learn More ⇒ Molina bulletin
In either case, the grace period starts on the date we mail members the first warning notice that their premium is overdue. The letter tells them when their grace period ends. It warns that they will lose their coverage unless they send us the full past due amount before the grace period ends. It says we won’t be able to reinstate them afterward, if their policy gets canceled for not paying premiums. We also send them one or more reminder letters repeating this information, depending on how long their grace period is.
Full payment is required to keep coverage in force
If any of your clients find themselves in a grace period situation, make sure they understand that making partial payments on the debt will not serve to extend the coverage period, stretch out the grace period or delay cancellation. After they’re notified about premiums overdue, they must pay the full amount owed before their grace period ends to avoid losing their coverage.
Here’s an example of how a three-month grace period works
Let’s say your client entered the grace period and owes premiums for two months. Here’s an example of what can happen:
• During the first month in grace period, your client’s health benefits stay in effect. And we will honor claims incurred during this period. Your client must still pay any unpaid premiums, copayments, coinsurance and deductible amounts, as set forth by the health plan.
• During the second and third months of the grace period, your client’s coverage will be suspended.
No one on the plan will be eligible for benefits, unless the full amount due is paid before the end of the grace period. During this time, we will not pay for any health care services, supplies or prescriptions, even if they were approved before.
Now, let’s say your client pays for one of the two overdue months right away. Doing so will not extend the grace period or delay suspension, as the grace period moves into the second month. Your client will be on the hook for any claims during this time while coverage is suspended, unless the account gets paid in full before the grace period ends.
Ultimately, if your client doesn’t pay the remaining amount due by the end of the grace period, we will cancel coverage. We also will refund the partial premium payment made in the second month because it doesn’t cover the full premium owed. We will only honor claims incurred in the first month of the grace period.
Premium payment grace period clarification
Regulations require a 90-day grace period for on-exchange members receiving subsidies for their health plan. For off-exchange members not receiving subsidies, the grace period is 30 days. For a member who is on a 90-day grace period and does not pay 100% of their total premium due, the grace period does not start over.
Example: A member owes $600.00 for their premium for March and April. In April, they pay one month’s premium for the month of March. In this scenario, the member is still in their 90-day grace period with 30 days left until they are cancelled. Blue Shield Agent Email 6.7.2016
Consequences of cancellation
Clients need to know that cancellation for not paying premiums can have serious consequences. Here’s what happens if they lose their coverage:
• They will still owe unpaid premiums for the first month of their grace period
• They will still owe providers for any health care services they got during the second and third months of the grace period
• They will have to repay any premium tax credits form 8962 1095 A the government paid on their behalf during the second and third months of the grace period
• They won’t be able to get new coverage for themselves or their dependents until the next open enrollment period, unless a life event triggers a special enrollment period
We understand how difficult situations like this can be. We’re willing to work with members to help them, and we offer the following options to help make payments easier:
• Pay Online – Clients can go to anthem.com/ca, log into their account and click on the Pay My Bill Online link
• Pay By Mail – Clients can mail their invoice with payment. They must mail in time for us to get it on or before the last day of the grace period.
• Pay By Phone – Clients can call the number on the back of their member ID card to use our free Auto Pay Phone Service. Or, they can call Member Services at (855) 634-3381 to pay by credit card or check.
Cancellation for Non-Pay – won’t be a qualifying event either!!!
Check the FULL policy, EOC – Evidence of Coverage here’s a specimen and see what the rules are on cancellation and notice. Then if you do decide to do an appeal, (page 151 in specimen policy) or view our webpage on appeals, you’ll know what to argue about.
|We’ve done these applications a couple of hundred times now. There is no charge for our service. Why bang your head?|
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- Was the cancellation legal? Web Visitor Q & A
Cancellations can be a real problem under AHCA – Donald Care with the continous coverage requirement, which then gives you a 30% surcharge.