What Happens If The Health Insurance Premium Is Not Paid?


Insurance – Presentation for YNPN – Nonprofit Law Blog

If the health insurance premium is not paid , the client loses all insurance coverage, although the process is not irreversible until the insurer notifies the client of the termination of the contract, which will occur, if the client does not resolve the payment, one month after the due date of the unpaid premium.

That is, the client has one month to resolve it, unless the contract establishes other terms, and normally his company will notify him of the non-payment as soon as it occurs, as well as the loss of all guarantees until the problem is resolved. payment of that premium.

Upon losing all the guarantees included in the coverage of your insurance, it will not be responsible for financing any of the treatments, hospitalizations, medications or rights included in your health insurance that either occur or have their origin during the period that elapses after not paying that premium and resolving the situation.

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In the event that the client does not take charge of that payment, and the following, that is, normalizes his situation, his access to the contracted coverage will not be normalized, something that will happen whenever three circumstances occur:

That the premium left unpaid is not the first after signing the contract
That the client pays that premium that he left unpaid
That the contract has not yet been resolved

First Default
If the premium that the customer does not pay is the first after the subscription of the contract, the company may terminate the contract immediately, request payment from the customer in a friendly manner to continue with the commitment acquired, demand payment of the premium by executive means .

That is to say, in this case the client does not have a month of margin to continue with his insurance, interrupted in terms of coverage as of non-payment, unless the insurance company invites him to do so, but it is optional. of the insurer to resolve the contract from the moment of non-payment.


What Happens If The Health Insurance Premium Is Not Paid?


If the customer pays the unpaid premium
If the client pays the unpaid premium in that first month before the insurer can cancel him, his insurance coverage is activated again 24 hours after the payment is made and until a new non-payment occurs.

If a new ailment or an accident occurs that requires the medical, hospital or pharmacological care included in your health insurance, you will not be able to access the contracted coverage at that time, nor when the insurance is reactivated after payment of the insurance. cousin.

Finally, if this ailment did not exist or was not declared at the time of contracting, in the risk assessment questionnaire prior to signing the contract, the client must inform the insurer, but it is understood that he will not be covered by these previous ailments.


If the contract has not been terminated
If the Insurance Company does not terminate the contract in writing one month after the expiration of the premium, as long as it is not the first (or immediately if it is the first), the client has the opportunity to normalize the situation by paying the premium or premiums unpaid, even if that period has passed.

In this case, that part of the Company not resolving at the time it can do so, one month after the non-payment, the client has six months to pay the unpaid premium or premiums and thus resume the contracted coverage.

If he does so, except that he has not been covered during the entire period between the expiration of the unpaid premium and its effective payment, and that the insurance will not cover needs arising in said period, the client recovers his coverage from the payment , as well as your right to renew your insurance when the annual period expires

If you do not do so in those six months, and the company does not notify you of the cancellation of your contract, it is automatically canceled after that six months, regardless of whether the client can be claimed by executive action for the payment of the first insurance premium. if that was the one that didn’t pay.

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Consequences of non-payment
In addition to losing access to health insurance coverage from the moment the non-payment occurs, and being able to terminate the contract as described above, the client risks being included in the lists of defaulters, which affects their creditworthiness, and can also face legal consequences, by breaching an annual contract signed by him, if the company takes him to court, which could force him to pay the unpaid premiums with default interest.
Other causes of unilateral cancellation
The non-payment of a monthly premium is the most important cause of termination of the health insurance contract by the insurer before its expiration, but not the only one

Two other possible causes of early cancellation are that the client has not declared in the risk assessment questionnaire or does not declare aspects of his health situation when he knows it, including those that occurred in the period between the non-payment of the premium and the subsequent payment. , or that the date of birth of the client or beneficiaries is not within the range of dates for which their health insurance offers those contracted coverages.
Another thing is the cancellation of the contract at the time of its tacit renewal, after the end of the annual insurance coverage, and which must be notified in writing by any of the parties (the client or their company), with the advance notice provided in the contract. contract that binds them, normally two months before expiration, if the insurer cancels. In this way, the client will have time to contract another health insurance that is activated on the first day of the following year and that his guarantees are not interrupted at any time.

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