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Effective: December 1, 2006 |
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28.10.05.05ar1 - MinnesotaCare Fee-for-Service (Archive) |
Archived: June 1, 2009 |
All MinnesotaCare enrollees have health care coverage through a managed care health plan. However, enrollees may have MinnesotaCare coverage on a fee-for-service (FFS) basis for a short period in the situations described below.
Adding a Newborn or Newly Adopted Child.
Continued Benefits During Appeal.
Premiums Paid After Cancellation.
Adding a Newborn or Newly Adopted Child
If the mother of a newborn or newly adopted child was not enrolled in a health plan for the month of birth or adoption, the child's MinnesotaCare coverage is FFS for the month of birth or adoption and any subsequent months pending health plan enrollment for the
Example:
Julie has two children enrolled in MinnesotaCare. She is not enrolled in MinnesotaCare. On October 2, she reports she had a baby on September 25.
Action:
Enroll the baby in MinnesotaCare FFS for September and October. Enroll the baby in the same health plan as the other children beginning in November, which is the next available month.
When a MinnesotaCare enrollee requests continued benefits pending the outcome of an appeal after cancellation, the enrollee's coverage is reinstated as FFS until the person can be reenrolled in the health plan for the next available month.
Example:
Joan's MinnesotaCare is canceled effective March 1. On March 3, she appeals the action and requests continued benefits. No payment was made to the health plan for March because her coverage was closed before .
Action:
If Joan pays her premium, reinstate her March coverage on a FFS basis. Reenroll Joan in the health plan for April if the appeal is still pending.
If a case in which the enrollee took all required action before the effective date of termination is reopened after the date:
l Reopen the case on a FFS basis for the first month.
l Reenroll the household in the health plan beginning the second month.
Example:
Andrew received a termination notice for October for failing to provide information. MinnesotaCare received the necessary information at the end of the month and determined that Andrew remains eligible. However, MinnesotaCare was not able to process the change before reinstatement ran on the last working day of September.
Action:
Reopen the case on a fee-for-service basis for October. Reenroll Andrew in his health plan beginning in November.
When enrollees canceled for nonpayment pay all billed premiums by the due date in the month following disenrollment and are reinstated back to the date of closing:
l Reinstate with FFS coverage for the reinstatement month.
l Reenroll them in their former health plans for the following month.
For further information, see: