Claims Processing After Retro-Termination for Marketplace Members

Jun 8, 2026 | Provider News

Effective June 15, 2026, and applicable to all Community First Marketplace plans, claims for dates of service during a Member’s policy grace period that were previously paid may be adjusted or recouped if the Member’s coverage is retroactively terminated due to non-payment of premium due.

Providers are encouraged to verify Member eligibility, coverage, and policy status prior to rendering services.

Action:

Providers are encouraged to share this information with their staff. If you have any questions about this notice, please email Provider Relations at ProviderRelations@cfhp.com or call 210-358-6030. You can also contact your Provider Relations Representative directly.

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Open Enrollment begins November 1! Community First offers qualified health plans on the Health Insurance Marketplace® for every budget and health care need. Questions? Call 1-888-512-2347 to speak with our licensed Marketplace team.

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