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Effective: December 1, 2006 |
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28.10.15ar1 - Enrollees With Other Health Care Coverage (Archive) |
Archived: June 1, 2009 |
People enrolled in Minnesota Health Care Programs (MHCP) who have other health care coverage must follow certain procedures to ensure proper payment for health services they receive.
Enrollees who have health insurance or HMO coverage must follow the plan's policies and use providers that participate with that plan. They must use coverage through an insurance plan or HMO before MHCP will pay for any services.
Note: Contact the if enrollees are unable to use their primary coverage due to their distance from network providers. BRS applies a general standard of 30 miles to determine whether network providers are accessible.
All MHCP enrollees are notified of these guidelines annually when DHS sends them Your Notice About Third-Party Liability (DHS-2810). This notice contains information about health insurance and .
are responsible for coordination of benefits for their enrollees. MHCP enrollees who receive coverage through managed care and have other health insurance must take the following steps:
l Contact their MCO before receiving health care services.
l Use the providers their MCO tells them to use.
l Inform their worker of changes in coverage.
Enrollees who receive MHCP coverage through fee-for-service and have other health insurance must:
l Use their private insurance or HMO coverage first. MHCP will not pay for services for enrollees who have not used the private coverage first.
l Follow their insurance plan's or HMO's rules to get care covered by the plan or HMO.
l Use providers who participate with MHCP and their private coverage, including following the plan's policy for referral to outside providers. Clients should ask about this policy when they schedule appointments to ensure payment for the services.