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pending a health insurance claim during the grace period
Benefits & Compensation
pending a health insurance claim during the grace period
Exchange ideas about health plans, retirement, work/life benefits, and employee assistance.
Has anyone heard of a prohibition against the pending of a health insurance claim during the grace period? I would think it's okay to do so long as the insurance company does not violate the maximum a
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pending a health insurance claim during the grace period
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pending a health insurance claim during the grace period
posted at 4/27/2010 11:00 AM EDT
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Posts: 8
First: 2/16/2009 Last: 4/28/2010 |
Has anyone heard of a prohibition against the pending of a health insurance claim during the grace period? I would think it's okay to do so long as the insurance company does not violate the maximum amount of time to pay a clean claim. |
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pending a health insurance claim during the grace period
posted at 4/28/2010 7:12 AM EDT
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Posts: 1047
First: 4/11/2002 Last: 9/14/2011 |
It does matter since this wouldn't come up on a group plan. How the carrier administers it when it comes to an individual plan or for a person on COBRA should be outlined in the Summary Plan Description. If you haven't paid premiums for a period in which claims are being incurred, I doubt the insurance carrier is going to pay the claim. |
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pending a health insurance claim during the grace period
posted at 4/28/2010 7:20 AM EDT
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Posts: 8
First: 2/16/2009 Last: 4/28/2010 |
it happens all the time with group plans. they choose not to pay the premium for their group until the very last day of the grace period, all the while claims are adding up. |
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pending a health insurance claim during the grace period
posted at 4/28/2010 7:25 AM EDT
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Posts: 1047
First: 4/11/2002 Last: 9/14/2011 |
Like I said, this situation doesn't come up on group plans. For group plans, yes, the claim would be paid unless premiums haven't been paid beyond the grace period. In this case, the insurance carrier has either canceled the group or may be willing to reinstate the group if premiums are paid ASAP.
Since you're asking this question, I'm assuming it concerns either an individual plan or COBRA. In this case, carriers may/probably administer these differently. |
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pending a health insurance claim during the grace period
posted at 4/28/2010 7:46 AM EDT
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Posts: 2146
First: 2/15/2006 Last: 9/14/2011 |
Just my brainstorming here....
Since we pay the COBRA payments directly to our provider under our group plan, the carrier has no way of knowing that the former employee has not made their premium and is in the grace period. The carrier requires us to pre-pay the premium. We dont' turn their benefits on and off each month....based on when they make that payment. If they fail to pay at the end of the grace period, they lose COBRA and are dropped retroactively back to the carrier. It would be up to our carrier then to retrieve any paid claims. Honestly the carrier already takes a while to process claims so I suspect that the timing would make it less likely that a claim would need to be suspended because it hasn't even finished processing yet. Maybe that is one reason insurance companies string out processing time! I suppose if you are self-insured you could try to do so, but it would be a nightmare to track unless you had a great system setup to do so on an almost daily basis. As for a situation where the employer isn't paying group premiums to the carrier in a timely manner, it would be up to the insurance contract to state what the consquences were during the grace period. Obviously there is a grace period for a reason....I suspect if the employer were late a lot, the carrier might have the rights to suspend claims. |
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pending a health insurance claim during the grace period
posted at 4/28/2010 7:56 AM EDT
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Posts: 1047
First: 4/11/2002 Last: 9/14/2011 |
Some carriers (or COBRA administrators)assume the administration of COBRA participants, so they may not be subject to the same parameters of the group when it comes to premium payments and grace periods. I've known carriers to terminate COBRA participants each and every month until premiums are received for the next month.
Really, it's going to come down to the SPD. If the COBRA participant or individual policy holder doesn't like the way the carrier administers the plan, he or she can either choose a different carrier (although they will probably administer it the same way) or pay his or her premiums earlier. |
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