M E M O R A N D U M

IM-102 5/31/01  MC+ PREMIUM INCREASE FMR#23 FHC MR#20


SUBJECT:
MC+ PREMIUM INCREASE
   FORMS MANUAL REV.#23 
   IM-32PRM - APPROVAL NOTICE FOR PREMIUM GROUP
   IM-4(PRM) - PREMIUM AMOUNTS BASED ON FAMILY SIZE AND INCOME
   IM-33MCC - MC+ NOTICE OF CHANGE
   IM-80MC - MC+ ADVANCE ADVERSE ACTION NOTICE
   MANUAL REVISION #20   FAMILY HEALTHCARE
   MANUAL SECTIONS: 0920.020.10.05, 0920.020.15, 0920.020.030.05, 0920.040.00
 
DISCUSSION:
Effective July 1, 2001 the premiums for MC+ for children with income above 225% of the federal poverty level will increase to a maximum of $218.  The way the premiums are determined will also change.  The premium will be based on family size (assistance group) and income to ensure that no family pays more than 5% of their income for coverage, with premiums ranging from a minimum of $55 to the maximum of $218 per month.  Affordable healthcare coverage will be $290 per month effective July 1, 2001.  MC+ notices from DFS will no longer state the amount of the premium.  They will inform the family that they are required to pay a premium and will be notified of the amount by First Health, premium collection contractor.  There has been no change in the way eligibility will be determined.  Division of Medical Services (DMS) Data Processing will determine the premium amount based on the number of persons listed in Field 29 and the gross income shown in field 41 of the IMU5.  First Health, premium collection agency, will then notify the household of the premium amount and how to make payment.  There will be no record available in the IM system to reference for the amount of the premium. 

First Health will include a notice of the change in premiums with the June invoices mailed June 1, 2001 for those active premium group families. (See attached).  Premiums paid in June for July coverage will remain $80.  Premiums collected in July for August coverage will be in the new amounts.

For new eligibles approved in June, the first month's premium is $80 and the subsequent months are at the new premium amounts.  If approved on or after July 1 the first and subsequent months are billed at the new amounts. 

References to the premium amount have been deleted from the IM-32PRM, IM-33MCC, and IM-80MC.  These forms now require information about family size and monthly income.  An IM-4(PRM),  Premium Amounts Based on Family Size and Income, has been produced and should be included when the above referenced forms are used.  It will be necessary to make copies for use until an initial supply is received.  Staff may also use this as a reference to respond to inquiries about the premium group. 

Hearing requests will be handled by DFS using normal hearing procedures.  Evidence presented at an appeal of a premium amount should include a copy of the invoice from First Health, copy of the budget used to arrive a monthly gross income and the IM-4(PRM) reflecting premium amounts based on income and household size.

 
NECESSARY ACTION:
  • Review this memorandum with appropriate staff.
  • Destroy old forms upon receipt of the revised forms.
  • Begin using the revised forms immediately upon receipt.
  • File the revised forms in the Forms Manual.
  • File the revised manual sections in the Family Healthcare Manual.

  •  
CW
Distribution #2
Attachments  (All files in Adobe Acrobat .pdf)
IM-32PRM           IM-32PRM Instructions
IM-33MCC          IM-33MCC Instructions
IM-4PRM             IM-4PRM Instructions
IM-80MC             IM-80MC Instructions



[ Memorandum Table of Contents ]

IM-101
 IM-103