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Effective: December 1, 2006 |
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28.05arc1 - Health Care Services and Benefit Sets (Archive) |
Archived: June 1, 2009 |
There are many different benefit sets for Minnesota Health Care Program (MHCP) enrollees. The benefit set may be determined by the major program for which an enrollee is eligible, by the specific eligibility group or basis of eligibility, or by other factors (such as household composition or income).
Note: Enrollees who receive health care services through a managed care delivery system may have additional provisions; see Managed Care Covered Services.
Each benefit set covers certain health care services or benefits.
l These benefit sets may cover a wide range of health care services (such as preventive care, emergency care, hospitalization, and home health care), or a more specific type of benefit (such as reimbursement of Medicare premiums).
l Some benefits sets include cost-sharing (as described below), or have limits on some services (such as a maximum dollar amount for inpatient hospitalization).
Enrollees may be required to pay a portion of the cost of a service, like a co-payment on a prescription drug. Others may have to pay a premium before their coverage will begin, like MinnesotaCare. These are examples of cost-sharing, in which enrollees may be responsible for some of the costs of their health care program coverage.
Some forms of cost-sharing are related directly to program eligibility requirements, and are discussed in other sections of this manual. See the following sections for more information on spenddowns, waiver obligations, premiums, and parental fees.
A general description of other types of cost-sharing is included in Benefit Sets by Program.
The information in this manual about covered services and benefit sets is provided as a general overview.
l For detailed information about covered services and benefit sets, see the MHCP Provider Manual (Chapter 2).
l For a client-oriented overview of services and benefit sets, see the MHCP benefit summary (DHS-3860). This form is sent to new health care program enrollees with a variety of notices.