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Effective: December 1, 2006 |
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25.05.15ar1 - MinnesotaCare Reinstatement (Archive) |
Archived: July 1, 2009 |
Clients, whose MinnesotaCare coverage is closed due to nonpayment of their premium, have until the 20th day of the reinstatement month to reinstate coverage.
Medical Support and Reinstatement.
Adding a New Member and Reinstatement.
MA Eligibility and Reinstatement.
Reinstate coverage only if both of the following criteria are met:
l Closure was due to nonpayment of premium.
Note: Enrollees who are canceled for nonpayment and another reason are not eligible for reinstatement. However, other household enrollees are eligible for reinstatement if they were canceled only for nonpayment.
l All billed premiums are paid by the end of the 20th day of the reinstatement month.
Note: If the 20th day falls on a weekend or holiday, the household must pay all billed premiums by the end of the following business day.
Example:
Jerry’s August premium notice is mailed on June 15. No payment has been received as of cutoff on July 17.
Action:
MMIS generates an overdue premium notice which includes a closure notice for July 31.
As of noon on the last business day of July, Jerry has not sent in his premium payment for August.
Action:
Jerry’s coverage ends July 31. He cannot re-enroll for MinnesotaCare until December unless he sends in the premium payment for August prior to August 20th.
MMIS sends a notice on the first day of the reinstatement month to households who are canceled for non-payment. The notice informs the household of the reinstatement option and includes the total amount due and the due date.
l MMIS will calculate the premium amount due for reinstatement based on the number of people who:
n Had coverage in the month before the reinstatement month.
n Could have coverage in the reinstatement month and the following month.
l If all billed premiums are received by the due date, MMIS reinstates coverage back to the date of closure and sends each enrollee a letter explaining that MinnesotaCare has been reinstated.
l Enrollees receive coverage through fee-for-service for the reinstatement month.
l MMIS will reenroll clients in their previous health plan beginning the month after reinstatement.
Example:
Mike, Judy and their daughter Debbie are enrolled in MinnesotaCare with a monthly premium of $100. MinnesotaCare is canceled effective July 31 due to nonpayment of the August premium. Mike’s coverage also ends because he has access to ESI. The August premium for Judy and Debbie is $67.
Action:
On August 1, MMIS generates a notice informing the household that they must pay $134 ($67 for August and $67 for September) by August 20 to have coverage reinstated back to August 1 for Judy and Debbie.
If payment is received by August 20, MMIS will reinstate coverage for Judy and Debbie back to August 1. Mike cannot have his coverage reinstated because he was closed for both nonpayment and access to ESI.
Medical Support Cooperation and Reinstatement
Do not change the MMIS RIND screen child support indictor during the 20-day reinstatement period.
Note: Track cases for enrollees who cancel for nonpayment and non-cooperation with medical support to update the RIND screen after the reinstatement period.
See the MMIS User Manual for more information on the RIND screen and the child support indicator.
Adding a New Member and Reinstatement
If a household asks to add new members:
l During the 20-day reinstatement period, all billed premiums during the 20-day period, including the premium for the next month, must be paid to:
n Reinstate household coverage.
n Begin coverage for the new member for month after reinstatement.
Note: The new member, who is pending awaiting payment, will be denied automatically by MMIS for nonpayment until the past due premium is paid.
Example:
Sally and John do not pay their premium for May and their coverage is closed for April 30 due to nonpayment.
On May 5, John requests to add his daughter Melanie, who has moved into the household. Melanie is determined eligible and is approved as pending awaiting payment for June.
Action:
MMIS automatically changes the pending awaiting payment span to denied for nonpayment because it is during the reinstatement period.
The family sends in the premium for May and June on May 18.
Action:
John and Sally’s coverage is reinstated back to May 1, and Melanie’s coverage will begin June 1.
l After the 20-day period reinstatement period the new member must pay for the next month’s premium to begin coverage for the new household member only. Closed household members will have a four-month penalty.
Example:
Lisa and Tom are closed for non-payment of their December premium. On December 5 Lisa calls to request coverage for her daughter, Allison, who just moved back into the home. The December and January premiums are received on December 24.
Action:
Only Allison will be eligible for coverage in January. Tom and Lisa have a four-month penalty for nonpayment of premium, because they did not pay the past due premium by December 20 and did not request good cause. A credit will be available on their case.
MA Eligibility and Reinstatement
MMIS will not automatically reinstate MinnesotaCare coverage for enrollees who pay the past due premium and are also approved for MA.
l MMIS will generate a worker message.
l Follow up with the enrollee to confirm that she wants MA coverage to continue.
l If the enrollee does continue MA, the MinnesotaCare re-bill procedure will recalculate the premium and create a credit.
Enrollees who are closed for nonpayment and whose renewal month is the month following the reinstatement month are sent a closing notice generated by MMIS at billing of the reinstatement month.
The notice indicates the following:
l All billed premiums must be paid and a completed renewal must be submitted by the 20th to be eligible for reinstatement.
l If the renewal is not received by the 20th the client is also being close for failure to renew.
If the client pays the premium but fails to submit the renewal, no further notice is required.
If the renewal is received after the 20th and the premium has been paid, process the renewal. See Renewals for more information on renewal requirements.
Example:
Joelle’s MinnesotaCare coverage is canceled for nonpayment on July 31. Her renewal month is September. As of August billing (15th) she has not paid her past due premium.
Action:
MMIS generates a notice advising her that she must pay the past due premium and submit her renewal by August 20 to be eligible for reinstatement.