Family MO HealthNet (MAGI) Manual – Table of Contents

1840.010.15.15 Private Insurance

IM#92, July 11, 2017

If affordable employer sponsored insurance is not available, evaluate access to affordable private insurance coverage.  FSD must refer to the Affordability Calculator to see if affordable insurance is available.  DO NOT require the family to provide insurance quotes unless they disagree with the calculator determination. If the family disagrees, they may give quotes verbally or in writing at a FSD office or through the FSD Information Center at 1-855-FSD-INFO (1-855-373-4636).

NOTE: Written verification from insurance companies is not required, but the applicant must supply names of the insurance companies.

NOTE: Undocumented immigrants do not have access to affordable insurance, as they cannot purchase an insurance plan through the Federally-Facilitated Market Place at www.Healthcare.gov.

A private insurance policy causes ineligibility if it:

  • covers all MO HealthNet services, except non-emergency medical transportation;
  • has a premium that meets the affordable definition in Section 1840.010.15; and
  • covers all the child’s pre-existing medical conditions.

If the private insurance quotes are above the affordable amount, the family does NOT have access to affordable insurance and the children are eligible on that factor. If one or both of the private insurance quotes are less than the affordable amount, the family has access to affordable insurance and the children are not eligible for CHIP premium coverage.