Grace periods for delinquent premium payments by members

What you need to know if your patients' premium payments are late.

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.

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