Family Healthcare (FAMIS) Manual

0920.020.10.05 Affordable Insurance Definition

IM-#23 April 26, 2016IM-#20 March 19, 2015IM-#16 March 20, 2014IM-#27 March 11, 2013IM-#18 March 13, 2012IM-#17 March 14, 2011IM-#14 March 5, 2009IM-#48 June 25, 2008IM-#71 August 1, 2007IM-#64 June 15, 2006IM-#83 August 2, 2005IM-#64 June 9, 2005IM-#56 June 9, 2004IM-#72 June 4, 2002IM-#59 May 30, 2002

Senate Bill 577 amended the affordability standard in Section 208.640 RSMo effective August 28, 2007. The new affordability standard is based upon a percentage of income for a family of three at 150%, 185%, or 225% of the FPL, depending upon the family’s gross income.

Families with income between 150% and 300% of the FPL with access to insurance must meet the following affordability guidelines:

  • For families with gross income above 150% up to and including 185% of FPL the affordability standard is based upon a monthly premium amount of 3% of 150% of the FPL for a family of three ($2520 x 3%=$75).
  • For families with gross income above 185% up to and including 225% of FPL the affordability standard is based upon a monthly premium amount of 4% of 185% of the FPL for a family of three ($3108 x 4%=$124).
  • For families with gross income above 225% up to and including 300% of FPL the affordability standard is based upon a monthly premium amount of 5% of 225% of FPL for a family of three ($3780 x 5%=$189).

Effective April 1, 2015, families with income between 150% and 300% of the FPL with access to insurance must have monthly health insurance premiums for the children compared to the following affordability standards:

  • 151%-185% of the FPL = $75/month
  • 186%-225% of the FPL = $124/month
  • 226%-300% of the FPL = $189/month

If insurance is available for the child(ren) at a cost below the affordability standards, the child(ren) is not eligible for the MO HealthNet for Kids SCHIP Premium healthcare coverage due to access to affordable health insurance. Refer to Section 0920.020.10 and Section 0920.020.10.10 if the child(ren) has a pre-existing condition that the health insurance plan does not cover, or if the child has exceeded annual benefits for all healthcare services.