ExchangeAdministrativeHigh impact
21-012 Reminder - Verify Eligibility for On-Exchange IFP Members in a Premium Grace Period to Avoid Claims Payment Issues
Health Net·CA·Reimbursement
We identified it
Jun 20, 2026
Summary
Health Net suspends eligibility for On-Exchange Individual and Family Plan (IFP) members during months two and three of the premium grace period when members are delinquent on payments. Providers must verify benefits and eligibility each time members are scheduled for services to avoid claims payment issues.
Action Required
Immediately: All staff must verify benefits and eligibility for every On-Exchange IFP member before each scheduled service. Front desk staff should check member eligibility status in the Health Net provider portal or through real-time eligibility verification. If member is in suspended status during months two or three of premium grace period, follow special billing procedures outlined in policy 21-012. Failure to verify eligibility may result in claim denials and payment issues.