14 Jun Grace Periods
What is a Grace Period?
A grace period is a set period of time that CGHC will give you to pay your premium payments before your coverage is terminated.
How will I know if my account has gone into a grace period?
If you have not paid every month of your premium payment in full, you have likely gone into a grace period. You will know for sure when you get a notification from us that your account has gone into grace. You will get a letter to the address we have on file outlining how to make a payment in order to come out of grace. This letter will also outline when your coverage will be terminated due to non-payment. You can also find this in your online payment portal. The portal will have a grace message in red on the top of the screen if you have outstanding payments.
Do different members have different grace periods?
Yes. Members who get a tax credit to make health insurance more affordable get a 90-day grace period. All members who do not receive a tax credit, get a 30-day grace period.
For example: Members with a Tax Credit: Your payment for April coverage is due on March 25th. If you do not make a payment for April of 2021, you will have 90 days before your coverage is terminated. Therefore, if you never make another payment on your account, your coverage will be terminated on July 1st. Members without a tax credit: Your payment for April coverage is due on March 25th. If you do not make a payment for April of 2021, you will have 30 days before your coverage is terminated. Therefore, if you never make another payment on your account, your coverage will be terminated on May 1st.
Will my claims be paid while my account is in a grace period?
Just like above, members who receive a tax credit and those who don’t have different grace rules. If you receive a tax credit, your claims will be paid for the first 30 days of the grace period. After those 30 days, CGHC will hold your claims in a “Pending” status and will not pay them until you are paid in full. If you do not receive a tax credit, your claims will not be paid when your account is in a grace period. CGHC will not pay for any medical or prescription claims until your account is paid in full.
If my account goes into a grace period, what can I do?
If your account goes into a grace period, all you need to do is make your payment for the balance in your account. This will get you out of the grace period completely and will put your account in good standing.
If my coverage is terminated due to non-payment, can’t I just re-enroll?
In most cases, no. If your coverage is terminated due to non-payment, you can only get new coverage through CGHC if you have a qualifying life event for a Special Enrollment Period or if it’s during the Open Enrollment Period. Termination due to non-payment is not a qualifying life event; therefore, you cannot enroll in health insurance through another ACA-compliant plan on the Marketplace until the next Open Enrollment Period.
Members may not be eligible for continuous coverage even with a Special Enrollment Period. This means, your coverage could be terminated for non-payment since the last time you paid. For example: Bob enrolled in coverage for 2021 but has not made a payment since December 2020. Bob’s coverage will be terminated for non-payment as of 12/31/2020. Even if he becomes eligible for a Special Enrollment Period on February 1st, none of his January claims would have been covered.
This can lead to a significant gap for members who get a tax credit, who can end up with a two-or-three-month gap after their 90 days of grace runs out. Members with an SEP can sometimes qualify for a retroactive effective date, which would provide coverage during the gap as long as the months are paid in full, but there are many exceptions to the rules.
Can I get my grace period extended beyond the 30 or 90 days offered?
No, CGHC cannot offer any extensions to the grace period.
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