Grace period and claims pending

Grace period: A short period after your monthly health insurance payment is due. If you haven't made your payment, you may do so during the grace period and avoid losing your health coverage or other penalty.

Claim pending: When a claim has been received but has not been approved or denied, finished or completed. It is waiting until the premium is paid or the plan is canceled due to nonpayment. It is simply in a waiting period. 

For premium grace periods, WellFirst Health follows the policies established by the Federally Facilitated Marketplace. See healthcare.gov.

APTC grace period: For a member receiving the APTC, your grace period for paying premiums is three calendar months. The grace period starts as of the first day of the month for which a premium payment was due but not paid. If a premium payment is not received by the end of the grace period, your coverage under this policy will terminate as of the last day of the first month of the APTC grace period. You will be responsible for paying all amounts owed to your provider(s) after the date your Policy terminates. You will owe premium for the first month of the APTC Grace period even if the entire premium due is not paid and the policy is terminated.

WellFirst Health will pay claims during the first month of your three-consecutive-month grace period. After that, WellFirst Health will not pay claims and you will be responsible for the cost of those claims unless the entire monthly premium due is paid prior to the end of the APTC grace period. Claims received for dates of service within the second and third month of your grace period will be pended, if the entire monthly premium due is not paid with your grace period these claims will be denied and you will be responsible for the charges. If your entire monthly premium due is paid within the grace period, pended claims will be processed according to your plan provisions.

If you choose to wait until the end of your grace period to pay your full premium, your medical and pharmacy claims will be pended starting the second month of your grace period until full payment is received.

Non-APTC grace period: For members not receiving the APTC, your grace period for paying premiums is 31 days from the first day of the month. If a premium payment is not received by the end of the grace period, your coverage under this policy will terminate at the end of the last month for which premium was received in full. Your claims will be pended during the grace period. You will be responsible for paying all amounts owed to your provider(s) after the date your policy terminates.


This information pertains only to our QHP plans.