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: |
Distribution #2 Attachments (All files in Adobe Acrobat .pdf) IM-32PRM IM-32PRM Instructions |
| IM-101 |