ExchangeAdministrativeHigh impact
20-093 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 requires providers to verify eligibility each time they see On-Exchange Individual and Family Plan members, as members in premium grace periods (months 2-3) have suspended eligibility and claims will be pended. Providers can still treat these patients but must collect payment directly from the member, as Health Net will only pay claims if the member later becomes current on premiums.
Action Required
Immediately: Front desk staff must verify eligibility through Health Net provider portal for ALL On-Exchange IFP members on the day of service. Select 'Health Net Commercial - CA' product type and use complete member ID or last name with DOB. For members showing suspended status (months 2-3 of grace period), collect full payment from patient before services or advise that services may be declined. Billing team must track these claims as they will be pended with code 'LZ - Pend: Non-Payment of Premium' and only paid if member becomes current on premiums.