Family Healthcare (FAMIS)

0920.020.05.10 Health Insurance Definition (MO HealthNet for Kids)

IM-34 April 23, 2008

Health insurance is defined as insurance that minimally provides coverage for physician’s services and hospitalization.

The term “health insurance” does not include short-term, accident, fixed indemnity, limited benefit or credit insurance, coverage issued as a supplement to liability insurance, insurance arising out of a workers’ compensation or similar law, automobile medical-payment insurance, or insurance under which benefits are payable with or without regard to fault and which is statutorily required to be contained in any liability insurance policy or equivalent self-insurance. Also, participation in the Caring Foundation for Children program is not considered health insurance.

Health insurance does not have to cover all medical conditions (such as pre-existing conditions) to cause ineligibility for the SCHIP groups. Individuals who have insurance, but have exceeded a maximum benefit for a covered service are also considered insured.

NOTE: Persons who have exceeded a lifetime maximum for all benefits under their plan are considered uninsured. In addition, persons who have insurance, but have exceeded the annual benefits of the plan for all healthcare services are considered uninsured. The applicant/participant must provide verification from his or her health plan that the child has reached the annual maximum for all plan benefits. The verification must provide a date when healthcare benefits will once again be available for the child. The eligibility specialist must set a reminder in FAMIS to re-determine case eligibility when healthcare benefits will be available for the child.