*** The Health Care Programs Manual (HCPM) has been replaced by the Minnesota Health Care Programs Eligibility Policy Manual (EPM) as of June 1, 2016.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: March 1, 2011 |
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25.05.30 - Premium Credits and Refunds |
Archived: June 1, 2016 (Previous Versions) |
MinnesotaCare premium payments are recorded in the Financial Control Subsystem of MMIS. An account is set up in Financial Control for each household to record when premiums are received and for what months the payment covers. Clients who show an excess of payments in their household’s account have a credit and may be eligible for a refund.
The household's account may be adjusted to show a credit if the health plan capitation has not been paid and one of the following conditions exists:
l A household member is approved for MA for a future month for which a premium has already been paid.
Note: MMIS will automatically re-bill the new amount.
l The household paid the premium in advance and the premium amount decreased during the time the payment covered.
Note: MMIS will automatically re-bill the future premiums the night the decrease is entered.
MMIS will make the adjustment and record the credit in 30 to 60 days if the premium decreases after the client pays a higher amount.
l The household paid the premium in advance and coverage was closed before the period the payment covered.
MMIS will cancel all billings for months after the eligibility end date and will create a credit.
l The household paid the premium in advance and MMIS has not yet issued a billing for one or more months covered by the advance payment.
The account will show a credit until all of the advance payment has been applied to premiums.
Generally, credits on active cases will be applied against future billings. If an active enrollee requests a refund of credit balances, submit and track a refund request following the procedures in this section.
Request a refund if coverage is closed and a credit is recorded.
l Check Financial Control whenever coverage is closed.
l If the household has a credit or will have one because of the closure, track and submit a refund request to the MMIS User Services Help Desk 31 days after the payment was posted.
Exception: Workers may request refunds for payments made by cash, money order, or cashier’s check any time after the payment is posted without waiting 31 days.
MMIS may refund the entire amount of a Web payment upon request and a partial refund after 90 days.
Contact the MMIS User Services Help Desk if you are unsure what payment method was used.
l People cannot receive a refund for any month for which a capitation payment has been made.
Exception: Households with one or more American Indian members who have verified their American Indian status may be eligible for a premium refund even if a capitation payment has been made. See Premium Exemption for Households With an American Indian Member.
MMIS issues refund checks every two weeks to the National Provider Identifier (NPI) listed for the person responsible for the premium payment on the MinnesotaCare case.
l Contact the household to confirm the mailing address before requesting a refund.
Note: Check the name and address attached to the NPI to confirm it is correct, not the case address on the RCAD screen.
l Enter the contact and the refund request in case notes.
l Households will receive refunds two to four weeks after the worker submits the refund request.
MMIS issues a monthly report of closed cases with credits.
l Verify the mailing address and initiate a refund if appropriate.
Note: Do not request refunds for cases for which you are unable to confirm the current mailing address.
See MMIS User Manual - MinnesotaCare - Fix Requests - Refunds for refund instructions.