Important Information about Grace Periods for our Valued Providers
While most of our enrolled members pay their monthly premium on time, we do have some who are
behind on their payments. The new healthcare law allows members extra time, or a “grace period,” to
pay their premium.
About the Grace Period
The grace period can last one month or three months, depending on certain circumstances:
 One-month Grace Period: For members who don’t get a government tax credit, or subsidy, that
pays part of their premium.
 Three-month Grace Period: For members who get a government subsidy by purchasing their
coverage at Access Health CT (the Exchange). Members who enrolled at Access Health CT have
the letters “NX” in their member ID number.
How We Handle Claims During the Grace Period
 We will continue to pay members’ claims for services received during a one-month grace period
or during the first month of a three-month grace period.
 We will pend claims for services they receive during the second and third months of the grace
period.
 If members pay the full amount they owe by the end of the third month, we will process the pended
claims.
 If they do not pay the full amount by the end of the third month, we will terminate their membership
back to the last day of the first month of the grace period. We will deny all pended claims incurred
during the second and third months. You can bill your patients directly. Per federal law, this
includes claims for prior authorized services.
Grace Period Examples
Let’s say a member paid for February but missed the March 1 due date for March coverage.
If the member has a one-month grace period:
 He or she has until March 31 to pay the premium owed.
 We will process claims for services the member received during March and pay you based on
the member’s coverage.
 If the member does not pay their premium by March 31, we will cancel his or her policy.
If the member has a three-month grace period:
 He or she has until May 31 to pay the March, April and May payments in full. And to continue
coverage after May 31, his or her June premium is due June 1.
 We will process claims for services you provide in March and pay you based on the member’s
coverage.
 We will pend claims for services you provide during April or May, and notify you of that.
 If we don’t receive the member’s payment in full by May 31, we will cancel his or her policy.
Confirming Member Eligibility
Please be sure to confirm your patients’ eligibility and grace period status prior to providing services.
This is especially important if the letters “NX” appear in their member ID number. To verify this
information, you must call 1-855-208-1641, Monday through Friday, 8:00am-6:00pm (ET).
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