30-Day Grace Period
If you do not pay your plan premiums by the first day of the month for which plan premiums are due, IEHP will send a Notice of Start of Grace Period which will provide:
(a) dollar amount due which must be paid in full to avoid termination of coverage.
(b) date of the last day of paid coverage.
(c) names of all enrollees affected by the notice.
(d) additional details regarding the grace period.
(e) consequences of losing coverage for nonpayment of Plan premiums.
(f) the date the grace period begins and expires
The grace period begins on the first day after the last day of paid coverage. For example, if you have not paid your February plan premium by January 31 for coverage beginning February 1, your grace period begins on February 1). Coverage will continue during the 30-day grace period. However, you are still responsible to pay unpaid premiums and any cost share or deductible amounts required under the EOC.
If full payment is not received by the end of the 30-day grace period, your coverage will be cancelled. IEHP will mail a termination notice that will provide the following information:
(a) that the EOC has been cancelled for non-payment of Plan Premiums.
(b) the specific date and time when coverage is terminated for the Subscriber and all Dependents.
(c) Your right to submit a grievance.
IEHP will allow one reinstatement during any twelve-month period, if the amounts owed are paid within 15 calendar days of the date the notice confirming your termination is mailed. If you do not obtain reinstatement of the cancelled coverage within the required 15 days or if coverage has previously been cancelled for non-payment of plan premiums during the previous contract year, then IEHP is not required to reinstate you and you will need to reapply for coverage. Amounts received after the termination date will be refunded to you by IEHP within 20 business days.
Three-Month Grace Period
Subscribers and enrolled dependents who are getting Federal Advance Premium Tax Credits (“APTC”) or California Premium Subsidy have a three-month grace period instead of a 30-day grace period for failure to pay plan premium charges. If you do not pay the outstanding plan premium for each family member receiving coverage for the month by the first day of the month for which plan premiums are due, IEHP will send you a Notice of Start of Federal Grace Period.
IEHP will pay claims for covered services during the first month of the three-month grace period. However, IEHP will suspend your coverage and pend claims for services in the second and third months of the three-month grace period. If you pay the entire amount of plan premiums due before the end of the three-month grace period, coverage that was suspended will be reinstated and IEHP will proceed to process pended claims for services rendered by health care providers in the second and third month of the three-month grace period.
If you do not pay the entire amount of outstanding plan premiums in full before the end of the three-month grace period, IEHP will terminate your coverage and indicate that your coverage effectively ended on the first day of the second month of your three-month grace period. IEHP will mail a termination notice. If IEHP terminates your coverage because you have not paid plan premiums in full before the end of the three-month grace period, any pended claims will be denied. Providers whose claims are denied by IEHP may bill you for payment and you may be responsible for payment. If your coverage terminates for this reason, you will not be allowed to reinstate coverage after the three-month grace period ends.