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Effective: March 1, 2007 |
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25.10.25ar2 - MA-EPD Good Cause for Late Payment (Archive) |
Archived: July 1, 2008 |
The Special Recovery Unit (SRU) and Health Care Policy at DHS are responsible for good cause determinations involving late MA-EPD premium payments.
Good cause is defined as circumstances beyond an enrollee's control or that the enrollee could not reasonably foresee which resulted in the enrollee being unable or failing to pay the premium or requesting voluntary cancellation.
Good cause circumstances include but are not limited to:
l Serious physical or mental illness.
l Lack of timely premium notices.
l MA-EPD coverage was dropped due to belief that other health coverage was available, and the other coverage does not materialize.
l A regular source of income on which the enrollee depended to pay the premium is not received.
Good cause does not include choosing to pay other household expenses instead of the premium.
Good cause determinations are made on a case-by-case basis based on the evidence the enrollee submits.
To request good cause, the client or authorized representative may submit a written request to:
DHS Special Recovery Unit,
MA-EPD Good Cause,
P.O. Box 64995,
St. Paul, MN 55164-0995.
Fax: (651) 431-7431.
The written request should include the client's:
l Legal name.
l PMI number.
l Mailing address.
l Phone number.
l Reason for requesting good cause.
l Supporting documentation.
DHS will provide the client with written notice of the decision within 30 days. Clients may appeal a finding that good cause does not exist.
SRU contacts the worker by sending either or both of the following:
l A copy of the approval or denial letter.
l A MAXIS e-mail.
SRU will notify the worker of whether the premium payment is made or not.
A finding of good cause does not relieve the client's obligation to pay the premium. SRU will notify the worker of whether the good cause premium payment is made or not.
Enrollees who have been granted good cause and set up a payment plan will continue to appear on the MA-EPD Overdue Premiums Report.
l Do not close these enrollees for late payment unless instructed to do so by DHS.
l If the client later pays the premium in full and is otherwise eligible, reinstate coverage back to the date of closure.