One reason for the

Narrow Network – 3 month Grace Period

is that DOCTORS, Hospitals & other providers do NOT get reimbursed if a policy gets cancelled, because the insured did not pay their portion of the subsidized premium in the 2 or 3 month of the grace period.  45 CFR 155.430 (b) (2) (ii) (A) & (B) and 156.270 (d) – Federal Regulation 41866

See our page on Balance Billing for information at AB 72 to help resolve the issue of going to a hospital or doctors office that is on the list, but still getting out of network bills.

(d) Grace period for recipients of advance payments of the premium tax credit. A QHP 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. During the grace period, the QHP issuer must:

(1) Pay all appropriate claims for services rendered to the enrollee during the first month of the grace period and may pend claims for services rendered to the enrollee in the second and third months of the grace period;

(2) Notify HHS of such non-payment; and,

(3) Notify providers of the possibility for denied claims when an enrollee is in the second and third months of the grace period.

(e) Advance payments of the premium tax credit. For the 3-month grace period described in paragraph (d) of this section, a QHP issuer must:

(1) Continue to collect advance payments of the premium tax credit on behalf of the enrollee from the Department of the Treasury.

(2) Return advance payments of the premium tax credit paid on the behalf of such enrollee for the second and third months of the grace period if the enrollee exhausts the grace period as described in paragraph (g) of this section. 156.270

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3 comments on “Narrow Networks – 3 month grace period

  1. I have Blue Shield Silver 1850 PPO individual and family plan- it is not covered California. I have had 3 different offices turn down our health insurance because they said it was a “mirrored plan” to covered California.

    Does covered California actually have a matching plan or are these people just misguided?

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