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Indiana Court Of Appeals Requires Health Insurer To Pay Medical Expenses Incurred During Grace Period For Late Premiums - Insurance Coverage

Insurance Coverage

Posted on: Mar 5, 2018

By Richard K. Shoultz and Michael R. Giordano, both of Lewis Wagner LLP

In Pelliccia v. Anthem Ins. Companies, Inc., 2018 WL 283152 (Ind. Ct. App. 2018), a doctor purchased a personal health insurance policy to cover him and his wife. The policy stated coverage would terminate if he failed to pay the monthly premium within the grace period.

In November 2014, the insurer pre-approved a surgery that the doctor had scheduled for December 2014, provided he was current on payment of the policy premiums.  On December 3, the doctor received a letter notifying him it had not received his premium for the month. The letter also explained that the policy would be cancelled if he did not pay the premium by January 3, 2015, but no claims would be paid during that period regardless. The doctor underwent his surgery, but he did not pay the premium by January 3, 2015.

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