ACA Grace Period
What is the 90-Day Grace Period?
The Affordable Care Act requires a 90-day grace period for certain members who purchased their health plan on the Health Insurance Marketplace. This grace period applies after the individual has paid at least one month’s premium within the benefit year and the next payment is not received by the due date for the following month.
How is BCBSWY Handling the Grace Period?
In cases when the member has become delinquent on their premium, Blue Cross Blue Shield of Wyoming (BCBSWY) will take the following steps, as defined by the ACA:
- BCBSWY will process claims for services received during the first month (30 days) of the grace period.
- BCBSWY will pend claims for services received during the second and third months of the grace period until the full premium for the 90 day grace period is received. Providers will be notified that the claim cannot be paid until the premium is received. The notification will also inform providers of the possibility of denied claims if the premium is not received by the end of the three-month (90 days) grace period. If the full premium is received, claims will automatically be processed. Providers will not need to resubmit the claims.
- After the third month (90 days) without full payment of premium, the member’s health plan will be cancelled and the pended claims will be denied. The member will be responsible for payment of services received during this time. BCBSWY will not retract payment for dates of service within the first month of the grace period.
- BCBSWY will notify members about unpaid premiums and grace period status by sending a delinquent premium letter as well as including a notation on their Explanation of Benefits.
- Grace period provisions may apply to certain BlueCard members.
- Prescription drug benefit claims submitted during the second and third months will be rejected.
How do I Verify Member Eligibility?
Providers are encouraged to verify a member’s eligibility prior to their appointment by using The Healthcare Online Resource (THOR) or a 270/271 transaction.
Register or Log in to THOR »
View BCBSWY guidelines for coverage.
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