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Effective: December 1, 2006 |
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25.05.05ar1 - Initial, Ongoing and Changes to Premiums (Archive) |
Archived: November 1, 2009 |
All 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.
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 you receive a premium at the county agency in error, 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 applications are approved.
Once 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. An overdue premium notice containing a closure notice is sent by MMIS 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 September.
l Coverage is closed unless the payment is received by noon on the last business day before the coverage month.
Exception: Do not close coverage for pregnant women and children under two.
Example:
Wanda’s March premium payment has not been received by February cutoff. Wanda is neither pregnant nor an infant.
Action:
MMIS sends an overdue premium notice containing a cancellation notice effective March 31. Coverage will remain closed unless the March payment is received by noon on the last business day of February.
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 Households 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 resulting 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 a manual adjustment must be requested.
l Automatic Adjustments.
Examples of situations when automatic adjustments take place include but are not limited to the following situations:
n A new member joins the household and the premium amount decreases.
n Coverage ended and there is a credit on file. See Premium Credits and Refunds for more information.
n MA is approved for a coverage month with a previously paid premium.
l Manual Adjustments.
A manual adjustment should be requested 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.
n A reported change is entered 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.