CMA releases fact sheets regarding Covered California grace period, updates toolkit February 7, 2014 General Grace Period, Health Care Reform, Health Insurance Exchange, Covered California 0 Recognizing the Affordable Care Act’s “grace period” provision to be one of the most confounding provisions of the law, the California Medical Association (CMA) has published an FAQ sheet dedicated entirely to helping physicians make sense of the issue. The fact sheet, “Covered California: Understanding the Grace Period for Subsidized Exchange Enrollees," is available through CMA’s exchange resource center. Federal law allows Covered California enrollees who receive financial subsidies to keep their health insurance for three months, even if they have stopped paying their premiums. This is known as the “grace period.” The first month of this grace period will be treated normally, and plans must pay for services rendered. In months two and three, however, the health plan may suspend payment for any services provided to these enrollees – and deny the claims if the enrollee’s coverage is terminated for non-payment of premiums at the end of the third month. In California, health plans will be required to suspend a subsidized enrollee’s coverage if the enrollee has not paid his or her premiums for more than a month. The health plans also will generally be required to notify the enrollee’s physician that the enrollee has entered month two of the grace period. In addition, CMA’s comprehensive toolkit on Covered California: "CMA’s Got You Covered: A physician’s guide to Covered California, the state’s health benefit exchange" was recently updated to reflect key developments in the exchange including the grace period, how plans are building their exchange networks, how to check physician participation status on the Covered California website, and steps physicians can take if they disagree with their participation status in the exchange plans. Comments are closed.
