*** The Health Care Programs Manual (HCPM) has been replaced by the Minnesota Health Care Programs Eligibility Policy Manual (EPM) as of June 1, 2016.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. ***
Effective: November 1, 2009 |
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25.05.25 - Forgiving Premiums |
Archived: June 1, 2016 (Previous Version) |
Certain people may not have to pay past due premiums to continue eligibility or when they reapply for coverage. Premiums are forgiven for people who do not have to pay past due premiums.
See Initial, Ongoing and Changes to Premiums for more information on how to request a manual premium adjustment when forgiving premiums.
Forgive past due premiums included in an approved bankruptcy order.
l Request a copy of the final order to verify whether the MinnesotaCare premium is included in the list of debts to be forgiven.
l Do not forgive premiums not specifically listed.
Pregnant women, during pregnancy and postpartum, and children under age two do not have to repay past due premiums and cannot be closed for failure to pay the premium amount.
Do not forgive premiums for future months or for premiums that have already been paid. Forgive the portion of the past due payments attributed to the pregnant woman or child under age two only at the following times:
l The other household members wish to re-enroll after their four-month penalty period.
Example:
Sally is pregnant and is enrolled in MinnesotaCare with her family. Her portion of the family’s $112 monthly premium is $20. The family does not pay the June premium amount.
Action:
Close all household members effective May 31 for failure to pay the premium, except for Sally because she is a pregnant woman. The other household members are assessed a four-month penalty for June through September.
Sally continues to be eligible for MinnesotaCare but does not pay her portion ($20) of the household premium for June, or her ongoing premium of $20 for July, August, or September. On September 18, Sally requests coverage for the rest of the household effective October 1.
Action:
Forgive Sally’s unpaid premiums for June through September ($80).
l The household wishes to add new members or new coverage for existing household members.
Example:
Krystle is pregnant and enrolled in MinnesotaCare. She fails to pay her June premium.
Action:
Krystle’s coverage continues because she is a pregnant woman.
On July 3, she reports that her son, age five, has moved in with her and asks to add him to her coverage effective August 1.
Action:
Forgive Krystle’s June and July premiums. Approve eligibility for her son and advise Krystle that she must pay the August premium by the last day of July to get coverage for her son.
l At the end of the pregnant woman’s 60-day postpartum period.
n MMIS sends a worker message alert in the last month of the pregnant woman’s postpartum period to report the end of postpartum and that the major program is being updated for effective the first of the next month.
n Forgive all unpaid premiums that have accumulated since the woman was designated as pregnant on MMIS that were not previously forgiven, or paid, including the months of pregnancy and the postpartum months.
n Eligibility will continue for the month after postpartum if the premium for that first non-pregnant month is paid by noon on the last business day of the last postpartum month and all other eligibility criteria are met.
Example:
Wilma is a pregnant woman enrolled in MinnesotaCare with her husband Tom. They fail to pay their August premium.
Action:
Tom’s coverage is closed for July 31 but continues for Wilma. Tom has a four-month penalty.
Wilma does not pay her premium for September and on September 15 she gives birth to their son Sam.
Action:
Wilma’s eligibility continues for September and Sam is enrolled in MinnesotaCare effective September 1.
The family does not pay the premium for October or November.
Action:
Wilma and Sam’s eligibility continues, because Wilma is in her postpartum period and Sam is an infant.
On November 17, MMIS creates a worker message to alert the worker that Wilma’s postpartum period is ending.
Action:
Forgive Wilma’s premiums for August and September, and Wilma’s portion of the premiums for October and November.
Wilma must pay the entire premium amount for December, which includes Sam’s portion of the premium, and meet all other eligibility criteria to continue her coverage.
Close Wilma's coverage if the December premium is not paid by noon on the last business day of the month. She will have a four-month penalty. Sam’s eligibility will continue because he is an infant.
Note: Forgive any of Sam's unpaid premiums if Tom re-enrolls.
l An infant turns age two.
n MMIS sends a worker message alert in the month the infant turns age two if the premium for the next month has not been paid.
n Forgive all unpaid premiums attributable to the infant that have accumulated before billing cutoff in the month of the infant’s second birthday.
n Eligibility will continue for the next month if the premium payment is received by noon on the last business day of the month and all other eligibility criteria are met.
Example:
Sam was enrolled in MinnesotaCare in his month of birth, September, as an auto newborn. The family has not paid premiums for him during his enrollment.
A worker message is generated to report Sam is turning two and he has not made a premium payment for October, the month following his second birthday.
Action:
Forgive Sam’s portion of the unpaid premiums for the month following his birth (October) through the month he turns two. Sam must pay the entire premium amount for the following month and meet all eligibility criteria to continue coverage.