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Effective: December 1, 2006 |
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15.05.15ar1 - Underinsured (Archive) |
Archived: November 1, 2008 |
Children under age 21 with Group 1 status who have current health care coverage that is determined underinsured may keep that coverage and enroll in MinnesotaCare, regardless if the insurance is determined ESI or not.
Consider a child as 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 Prescription drug coverage.
n Preventive and comprehensive dental coverage (with or without co-pays).
n Preventive and comprehensive vision coverage (with or without co-pays).
Preventative coverage describes services that keep people healthy and promote continuous health care. Services include routine physical exams, immunizations and prenatal care.
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 pre-existing condition.
Note: The child does not have to have the pre-existing condition to meet this requirement.
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 MinnesotaCare Insurance Barriers to determine when someone who is underinsured can be eligible for MinnesotaCare.