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Effective: April 1, 2012 | |
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02.10 - Benefit Sets |
There are many different benefit sets for Minnesota Health Care Program enrollees A person receiving coverage through a Minnesota Health Care Program or a managed care organization (MCO).. Each benefit set includes covered services. Some include co-payments, other cost-sharing amounts, or limits. These may vary based on the eligibility of the enrollee or household.
l Covered services - Most benefit sets include a wide range of health care services, from preventive care to hospitalization. Some include more limited services, such as reimbursement of Medicare A federal health insurance program for people who are age 65 or older, disabled, blind, or have permanent kidney failure. premiums.
l Limits - Some benefits are limited. There may be a limit or maximum dollar amount on a specific type of service, like hospitalization, or on all services in a category, like dental.
l Cost-sharing - Some enrollees will have to pay a portion of a service, like a co-payment for a prescription drug. Others may have to pay a premium before their coverage will begin. See Medical Assistance (MA) Copays and Family Deductible (DHS-3723) for information on the five-percent cap on cost-sharing.
An overview of the benefit sets for MinnesotaCare and Medical Assistance (MA) is given on the Minnesota Health Care Programs benefit summary (DHS-3860). This form is sent to new health care program enrollees.
For more information, see the Prepaid MHCP Manual.