21-012 Reminder - Verify Eligibility for On-Exchange IFP Members in a Premium Grace Period to Avoid Claims Payment Issues

Date: 01/15/21

This information applies to Physicians, Participating Physician Groups (PPGs), Hospitals, and Ancillary providers.

Providers must verify benefits, eligibility and cost shares each time a member is scheduled to receive services

As a reminder, Health Net suspends qualified members’ eligibility during months two and three of the three-month federal premium delinquency grace period if members are delinquent on premium payments. A summary update was communicated in 21-012sum.

Comprehensive information about the following is available in the complete update, 21-012, Reminder: Verify Eligibility for On-Exchange IFP Members in a Premium Grace Period to Avoid Claims Payment Issues, including:

• Premium grace period for members receiving premium assistance [federal Advance Premium Tax Credits (APTCs)] and/or California premium subsidies.
• How to bill covered services for members in suspended status during months two and three.
• How to verify eligibility for Individual and Family Plan (IFP) members.