SUBJECT:
INVOICING THE TRANSITIONAL CHIP LOC 2 CASES
DISCUSSION:
CHIP cases that transitioned to the Premium Group Level of Care (LOC) 2 on August 28, 2005, are receiving a special schedule of invoices. These invoices are for October, November and December 2005 coverage. This is to ensure that opportunities are available for families to continue MC+ healthcare for their children. Once one of these invoices is paid prior to the month the premium is for, the family will begin receiving Recurring Invoices on the normal schedule. No CHIP transitional case will be subject to a six-month penalty for non-payment of premium unless they have received and failed to pay a Recurring Invoice.
Initial Invoices:
Initial Invoices were originally sent out for the Transitional LOC 2 on September 1, 2005. The invoices informed families that the premium payment needed to be received by September 30, 2005, in order for the family to continue to receive healthcare coverage for their child(ren) for the month of October 2005. These invoices also state that families have until November 30, 2005 to pay their premium. The Initial Invoice only provides MC+ coverage for October 2005. The family will receive separate invoices for November and December 2005.
For families whose payment was not received at the DMS Premium Collections Unit by September 15, 2005, a Follow-Up notice was sent September 16, 2005, reminding families of the need to pay their premium in order to have coverage after September 30, 2005.
Families who have paid their Initial Invoice by September 30, 2005, do not experience a break in coverage. These families will be sent a Recurring Invoice October 2005. If a family fails to pay the Recurring Invoice, the CHIP case will close for failure to pay the premium and the family is subject to a six-month period of ineligibility for CHIP Premium coverage.
Families that did not paid their premium by September 30, 2005, did not have CHIP coverage beginning October 1, 2005. During October these families may still send in the premium with the Initial Invoice to receive coverage for October. Coverage will begin the date in October that the payment is received by the Premium Collections Unit and end October 31, 2005.
As of November 1, 2005, the Initial Invoice is closed and can no longer be used for coverage (the Initial Invoice is for coverage in October only). Any premium payment received after October 31, 2005, with this invoice enclosed will be applied to coverage in November.
Special November Invoices:
Families that did not pay their Initial premium by September 30, 2005, will be mailed a Special November Invoice 
(see attached sample of invoice) on October 6, 2005. The Special November Invoice is for November, 2005 coverage. Premium amounts on the invoice will reflect budget information in IMU5 as of September 30.
If the Special November Invoice is paid by October 31, 2005, the children will have coverage for the entire month of November 2005. These families will be sent a Recurring Invoice November 4, 2005 for December 2005 coverage. If the family fails to pay the premium, the CHIP case will close and the family is subject to a six-month period of ineligibility for CHIP Premium coverage.
If the November Special Invoice is paid in November, coverage begins the date the payment is received and ends November 30, 2005. Coverage will not continue past this date unless the Special December Invoice is also paid prior to November 30, 2005.
Special December Invoices:
If the family has not paid the Special November Invoice by October 31, 2005, a Special December Invoice will be sent November 4, 2005. The Special December Invoice is for December 2005 coverage. The premium amount on the invoice will reflect budget information in IMU5 as of October 31. The premium payment must be received by November 30, 2005, or the CHIP case will close.
If the Special December Invoice is paid by November 30, the first Recurring Invoice will be sent December 5, 2005. If the family fails to pay the premium, the CHIP case will close and the family is subject to a six-month period of ineligibility for CHIP Premium coverage.
Possible Premium Payment Scenarios:
Families who did not pay the initial premium in September have the following payment options:
- Pay only the Initial Invoice in October 2005. Coverage begins the date in October that the payment is received by the Premium Collections Unit and ends October 31, 2005. If the Special November Invoice is not paid in October, a Special December Invoice will be sent November 4, 2005. Failure to pay the Special December Invoice by November 30, 2005 will result in the case being closed. There will be no six-month penalty imposed for failure to pay the premium, as a Recurring Invoice has not occurred in this scenario.
- Pay the Initial Invoice and the Special November Invoice in October. Coverage begins the date the payment for the Initial Invoice is received. Since the Special November Invoice payment is received prior to the coverage period, the family's first Recurring Invoice will be sent in November. If the family fails to pay the Recurring Invoice, the CHIP case will close for failure to pay the premium and be subject to a six-month period of ineligibility for CHIP coverage.
- Pay only the Special November Invoice in October. Coverage begins November 1, 2005. The family's first Recurring Invoice will be sent November 2005 for December coverage
- Pay the Initial Invoice in October and pay the Special November Invoice in November. Coverage for October begins the date in October the payment is received through the end of October. Coverage for November begins the date in November the payment is received through the end of November. Since neither invoice was paid prior to the month of coverage, the Special December Invoice will be sent November 4, 2005.
The attached Flow Chart illustrates how the above applies.
MPNI Screens:
The following is an example of an MPNI screen where the Initial Invoice was not paid by September 30, 2005. The Initial Invoice (“I” under column labeled “Invoice Type”) shows still opened as coverage for October 2005 has not been paid as yet. The Special November Invoice (“N” for November) shows Notice Type “Transition November,” with a notice mail date of October 6, 2005.
The Next Notice Type at this time states “Initial Closing.” If the Special November Invoice is paid by October 31, the Invoice Status will show “Closed” and the Recurring Invoice for December coverage will appear after the first of the month. If the Special November Invoice is not paid by October 31, the Invoice Status will change to “Closed.”
If the Special December Invoice is sent, a “D” for December will be in the “Invoice Type” column and the “Notice Type” will be “Transition December.”
NECESSARY ACTION:
- Share this memo with appropriate staff.
ATTACHMENT:
Special November Invoice
CHIP LOC 2 Transition to Premium Flow Chart