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• Begins on the first day of the month for which the premium is unpaid, or the first day of the month following the date on which the plan bills the enrollee for the actual premium amount due, whichever is later.

NOTE: For individuals who have requested communications in an accessible format, the notification of unpaid premiums (e.g., the bill) are not considered delivered, and thus the grace period cannot begin until the organization fulfills its legal obligation, under Section 504 of the Rehabilitation Act of 1973, to provide the notification in an accessible format.

Option 1 – Plans may establish a grace period, not less than two whole calendar months, to start on the first day of the month for which the premium is unpaid, or the first day of the month following the date on which premium payment is requested, whichever is later.

If the overdue premium and all other premiums that become due during the grace period (in accordance with the terms of the enrollee’s agreement with the plan) are not paid in full by the end of the grace period, the plan may terminate or reduce (if applicable) the enrollee’s coverage. The enrollee must be notified of, or billed for, the actual premium amount due before the premium can be considered unpaid.

Example: Plan QR has a three-month grace period for premium payment. The plan billed Mrs. Stone in June. Mrs. Stone’s premium was due on July 1. She did not pay this premium and on July 6, the plan sent an appropriate notice of her delinquency. The enrollee ignores this notice and all subsequent premium bills. The grace period is the months of July, August, and September (three months). If she does not pay her July, August, and September premiums by the last day of September, she will be disenrolled from the plan, effective October 1.

Option 2 – Plans may use a “rollover” approach in applying the grace period

Under the “rollover” approach, the grace period would begin on the first day of the month for which the premium is unpaid, or the first day of the month following the date on which the plan bills. If the overdue premium for that month is not paid by the end of the grace period, the plan may terminate or reduce (if applicable) the enrollee’s coverage. With this option, disenrollment occurs only if the unpaid premium on which the grace period began is not paid in full by the end of that period; subsequent premiums that become due during the grace period are not a factor in the plan’s decision to disenroll at the end of that period. If the enrollee pays the premium for the first month of the grace period in full by the end of that period, the individual is not disenrolled. Failure to pay the premium for a subsequent month establishes a new grace period and a new disenrollment date. This process continues until the enrollee resolves the delinquency prior to expiration of the grace period and is not delinquent for any subsequent months.

Plans are not required to issue new notices each time the enrollee submits a partial premium payment (i.e., less than one month’s premium), since this would not result in a change in the proposed disenrollment date. However, since payment of at least one month’s past due premium causes the disenrollment date to “roll over” (i.e., move forward) commensurate with the number of month’s premium received, plans must issue a notice warning of the potential for involuntary