Family Healthcare (FAMIS)

0920.030.10 Premium Group Special Procedures

IM-99 October 2, 2007,  IM-#130 November 4, 2005  IM-#67 July 13, 2004

The beginning eligibility date for premium group children (LOC 2 and LOC 3, CHIP73, CHIP74 and CHIP75) does not reflect coverage for MC+. This date simply indicates the earliest date the individual can become eligible. The children do not have coverage until the premium is paid.

  • For Reduced Premium Group children – LOC 2, CHIP73, CHIP74: The eligibility date begins on the date of application, or first of the following month if not eligible month of application. Coverage begins on the date of application, or the date the premium is paid, whichever is later.
  • For Full Premium Group children – LOC 3, CHIP75:
    • For children without special healthcare needs, the eligibility date begins 30 days from the date of application. Coverage begins 30 days from the date of application or the date the premium is paid, whichever is later.
    • For children determined to have special healthcare needs, the eligibility date begins on the date of application. Coverage begins on the date of application or the date the premium is paid, whichever is later. Refer to Section 0920.020.05.20 for the special healthcare needs exception to the 30-day waiting period.

Upon approval, a premium notice is sent to the parent(s) or guardian(s) notifying them the premium payment is due upon receipt of the notice and must be received before coverage can begin. If payment is not received within 15 days, a second and final notice is sent requesting payment. If the initial premium is not paid MHD will notify FSD after 90 days to close the case. Data Processing will close the case and notify the caseworker of the closing. No Adverse Action Notice (IM-80 or FA450) or closing letter is required.

If the premium is paid, the MCII screen will be used to show coverage dates. Persons in fee-for-service will be assigned a pseudo plan number. Persons in managed care counties will be assigned to a pseudo plan number until enrolled in a health plan. To determine if the premium has been paid and the individual is actually eligible, refer to the MCII screen that shows if the individual is locked in. If there is no lock-in, the children are not eligible to receive services.