*** The Health Care Programs Manual (HCPM) has been replaced by the Minnesota Health Care Programs Eligibility Policy Manual (EPM) as of June 1, 2016.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. ***
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Effective: November 1, 2012 |
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25.05.05 - Initial, Ongoing and Changes to Premiums |
Archived: June 1, 2016 (Previous Versions) |
Most MinnesotaCare enrollees must pay a premium to establish and maintain coverage. Paying the initial premium activates a person’s coverage for the month following the month the premium is paid.
Clients requesting retroactive MinnesotaCare must also pay premiums for the retroactive months to receive coverage in those months.
Exception: Households that include one or more American Indian members who have verified their American Indian status and who are enrolled in MinnesotaCare are exempt from paying a premium. See Premium Exemption for Households With an American Indian Member for more information.
Children in households with income equal to or less than 200% FPG and children in enrolled in MinnesotaCare for Certain Children Exiting Foster Care or a Juvenile Residential Correctional Facility are also exempt from paying a premium.
DHS collects and posts all initial and ongoing payments regardless of the household’s choice of enrollment site. MMIS sends the initial premium notice when eligibility is approved. Clients have four months to pay the initial premium.
If the county agency receives a premium payment, forward it to:
DHS-MinnesotaCare,
Attn. Cashier,
PO Box 64834,
St. Paul, MN 55164-0834.
Return initial premium payments received with applications to the applicants. Inform applicants that they will receive a First Premium Notice if their application is approved.
After the initial payment is received and a case becomes active, monthly premiums are billed approximately six weeks before the first day of the coverage month.
l The ongoing premium is due approximately two weeks before the first day of the coverage month. MMIS sends an overdue premium notice containing a closure notice if payment is not received by the premium due date.
Example:
MMIS sends Elijah his October premium billing on August 15. The October premium is due by the September cutoff date (approximately September 15). Elijah has not returned the premium payment as of September 15.
Action:
MMIS sends an overdue premium notice containing a closure notice effective the end of September.
l MMIS closes coverage unless DHS receives the payment by noon on the last business day before the coverage month.
Exception: Coverage is not closed for pregnant women, children under age two and children living in households with income equal to or less than 200% FPG.
Example:
Wanda’s April premium payment has not been received by March cutoff. Wanda is neither pregnant nor a child under age two.
Action:
MMIS sends an overdue premium notice containing a closure notice effective March 31. Coverage will remain closed unless DHS receives the April payment by noon on the last business day of March.
l People who pay all billed premiums by the 20th day following the effective date of close may be reinstated. See MinnesotaCare Reinstatement for more information.
l People who are not reinstated must serve a four-month penalty period unless they show good cause for nonpayment. See Four-Month Penalty for more information.
Update MMIS to recalculate the premium amount. Take action immediately to change the premium amount in the following instances:
l Renewal.
l Income changes. Act on the change immediately.
l Household size changes.
l A household member is removed from coverage.
MMIS will make mass changes when:
l A change in law takes place.
l The yearly adjustment to the Federal Poverty Guidelines (FPG) are completed.
MMIS automatically adjusts most premiums when a change is made; however, there are some situations when it is necessary to request a manual adjustment.
l Automatic Adjustments.
Examples of situations when automatic premium adjustments take place after the eligibility approval include but are not limited to the following situations:
n A new member joins the household and the premium amount decreases or increases.
n Coverage ends, the client paid a premium for a future month, and capitation for the future month has not been paid. MMIS will create a credit. See Premium Credits and Refunds for more information.
n MA is approved for a coverage month with a previously paid premium.
l Manual Adjustments.
Request a manual premium adjustment only for premiums that have been billed in the following situations:
n A decrease in income is entered on a closed or denied obligation status (for example, the client reports a change in income after the fact).
n A reported change is entered in MMIS after the end of the month which changes the premium amount.
n When forgiving premiums.
n A worker error is discovered.
See the MMIS User Manual - MinnesotaCare - Fix Requests - Premium Adjustments for more information on requesting a premium adjustment.