*** The Health Care Programs Manual (HCPM) has been replaced by the Minnesota Health Care Programs Eligibility Policy Manual (EPM) as of June 1, 2016. Please refer to the EPM for current health care program policy information. ***
Effective: September 1, 2012 |
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15.05.15 - MinnesotaCare Underinsured Children |
Archived: June 1, 2016 (Previous Versions) |
Children under age 21 who are underinsured with current health care coverage may keep that coverage and enroll in MinnesotaCare, whether or not the insurance is determined ESI if they:
l have household income at or below 200% FPG, or
l meet the Children's Health Plan (CHP) exception.
Verifying Underinsured Coverage.
Consider a child to be underinsured if the other health care coverage meets one of the following:
l Lacks coverage in two or more of the following areas:
n Basic hospital insurance.
n Medical-surgical insurance.
n Major medical coverage.
n Prescription drug coverage.
n Preventive or comprehensive dental coverage (with or without co-pays).
n Preventive or comprehensive vision coverage (with or without co-pays).
m Preventive coverage describes services that keep people healthy and promote continuous health care. Services include routine oral exams, prophylaxis, and x-rays.
m Comprehensive coverage describes a broad range of services including the diagnosis and treatment of most illnesses and injuries.
l Has a deductible of $100 or more per person per year.
Note: If the policy has a per family rather than a per person deductible, divide the deductible by the number of family members covered by the policy to arrive at a per person amount.
l Excludes services for a particular diagnosis.
Note: The child does not have to have the particular diagnosis to meet this requirement.
Example:
Two-year-old Anna has health care coverage provided by her father’s employer.
Services related to the treatment of autism are not covered. Anna does
not have autism.
Action:
Consider Anna underinsured because the insurance policy would not cover
any treatment if she were diagnosed with autism in the future.
l Excludes services for a pre-existing condition.
Note: The child must have the pre-existing condition to meet this requirement.
Example:
Alma recently purchased an insurance policy to cover her son Luis and herself.
The policy does not cover any pre-existing conditions.
Action:
Do not consider Luis underinsured because he does not have any pre-existing
conditions.
l Excludes coverage for a particular diagnosis because the child has exceeded the policy’s maximum coverage for that particular diagnosis.
l The client is a child who is enrolled in Medicare Part A, Part B, or both. See Other Health Care Coverage for MinnesotaCare for more information about Medicare.
See MinnesotaCare Other Health Care Coverage Barriers to determine when someone who is underinsured can be eligible for MinnesotaCare.
Verify that the child’s other health care coverage meets the requirements for being underinsured by reviewing the policy or contacting the insurer.
Note: The insurance company may require a signed release of information.