Sometimes premium payments are late. If one of your patients is in this situation, we will give them some time to catch up on payments, also known as a grace period. Here is what you need to know about grace periods and suspension for individual and family
plan (IFP) members:
- Required by California law, all Sharp Health Plan members are given a 30-day grace period, which starts the month that their premium is due.
- Members can access care during the 30-day grace period. If they have a plan with Covered California and receive a subsidy through the Advanced Premium Tax Credit (APTC), they will receive an additional 60 days on top of the 30-day grace period to
their overdue premium.
- Members are still responsible to pay all unpaid premiums as well as any copayments, coinsurance or deductible amounts required under their health plan.
- If a member does not pay within 30 days on a subsidized individual and family plan, we will suspend the member's health plan. After an additional 60 days, the member's plan will be terminated.
- If a member is on an individual and family plan that is not subsidized by Covered California, and does not pay within 30 days, we will terminate the member's plan.
- Sharp Health Plan cannot cover care when a member's health plan has been suspended. If the overdue amount is not paid in full by the end of the 30-day grace period or 90-day grace period for those who receive Covered California subsidies, their coverage
with Sharp Health Plan will end.
- For a member to avoid suspension, they must pay all outstanding balances by the last day of their grace period, which starts at 12:01 a.m. of the following month. For example, if their grace period ends in June, they must pay in full by June 30 to
reinstate coverage starting July 1.