If you miss the due date for a premium payment, you have extra time to make that payment. This is known as the "grace period." During this time, your health care coverage will not be cancelled, although you may see some changes in your coverage, as outlined below.
The length of the additional time and the changes depend on whether you have an Exchange plan with an Advanced Premium Tax Credit (tax credit).
For members with a tax credit: If your premium payment is past due, you have up to 3 months to pay your premium and to keep from losing your coverage. While you may get health care during those 3 months, it does not mean all your claims will be covered by your plan.
In particular, if you receive services in the 2nd and 3rd months of the grace period without paying your full premium, your claims will be pended. This means that no payments will be made to your provider until you pay your premium in full. If you do not pay your past-due premiums in full, you will lose your health care coverage. If this happens, your plan will not pay your medical bills and you could be responsible for paying the entire amount of your medical bills for care you received during the 2nd and 3rd months of the grace period.
During the grace period, BCBSNM will:
- Process claims for services received during the 1st month of the grace period and pend and not process claims for covered services received in the 2nd and 3rd months of the grace period. This means that no payments will be made to your provider until you pay your premium in full.
- Notify the Department of Health and Human Services of your non-payment of premium.
- Notify providers that your claims may be denied for services provided during the 2nd and 3rd months of your grace period.
If you get behind on paying your premium, you must pay all past-due premiums before the end of the 3rd month that your payment is late. If the premiums are past due for more than 3 months, your plan coverage will be terminated and your plan will not pay any of your medical bills for services provided during your grace period. If your coverage is terminated, you will not be able to enroll in a new plan until the next open enrollment period unless you qualify for a Special Enrollment Period.
For members without a tax credit: After your premium payments are late, you must get your account current within 31 days of the payment due date. After 31 days, your policy will be cancelled. If you receive health care during this 31-day period, you may be responsible for paying the entire amount of your medical bills. You must pay all of your outstanding premiums to keep your coverage. If your coverage is cancelled, you will not be able to enroll in a new plan until the next open enrollment period unless you qualify for a Special Enrollment Period.
Prescription Drug Benefits and the Grace Period
Missing your premium payment also affects your prescription drug coverage.
For members with a tax credit: During the 1st month of the grace period, you may not see changes to your prescription drug coverage. During the 2nd and 3rd months of the grace period, your plan will not pay for your prescriptions and you will be responsible for the full discounted retail amount of your prescription until your premium is paid in full. Once you pay your premium and that payment is processed, your full prescription benefits will be restored. At this time, you can submit any claims for prescriptions you had filled during the grace period for reimbursement of the difference.
For members without a tax credit: During the grace period, you may not see changes to your prescription drug coverage. However, if you do not pay your premium in full by the end of the 31-day grace period, your coverage will be cancelled. In addition, we will bill you for prescriptions we covered during the grace period.