M E M O R A N D U M

IM-128  09/17/99 MC+ INSURANCE PREMIUM QUOTES
 FORMS MANUAL REVISION #36:  IM-1UA, MC+ APPLICATION


SUBJECT:
MC+ INSURANCE PREMIUM QUOTES
FORMS MANUAL REVISION #36:  IM-1UA, MC+ APPLICATION
 
DISCUSSION:
Effective immediately, for all new MC+ applications, families in the Premium group (income above 225% of poverty) must provide quotes on the cost of health insurance for their children from two private insurance companies.  Written verification from the insurance companies is not required, but the applicant must supply names of the insurance companies.

The IM-1UA has been revised to obtain this information.  Question 4, of the Health Insurance section, now requests the name of two insurance companies and the cost of coverage from each.

Use the definition of "Access to Affordable Insurance" as described in this memo.  Children in the premium group are not eligible if they have access to:

  1. Employer sponsored health insurance with a premium of $90.00 or less per month; or

    2.  
  2. A private insurance policy that:

    3.  
    • Covers all MC+ healthcare services, except non-emergency medical transportation;
    • Has a premium of $90.00 or less per month for all the children;
    • Does not require deductibles, co-insurance, or co-pays that are more than $10 at the time of each professional visit and $5 per prescription as required by the MC+ program; and
    • Covers all of the children's pre-existing medical conditions.
Employer sponsored insurance does not have to meet the above requirements, other than a premium of $90.00 or less per month.

Attached is the MC+ Insurance Company Quotes form which has been developed to assist the applicants with children in the premium group obtain information from private insurance companies.  Send the form with mail-out applications ONLY if you know the family's income is above 225% FPL.  If after receiving the application, you determine the family has income above 225%, determine the action needed in accordance with the following guidance:

  1. If they have employer sponsored insurance that costs more than $90.00 or less, the family has access to affordable insurance and is not eligible.  Reject the application on that basis.

    2.  
  2. If they have employer sponsored insurance that costs more than $90.00 OR employer sponsored insurance is not available, the action taken depends on the quotes on the IM-1UA for private insurance.
    • If the private insurance quotes are above $90, the family does NOT have access to affordable insurance and are eligible on that factor of eligibility.
    • If one or both of the private insurance quotes are less than $90, send the applicant the MC+ Insurance Company Quotes form for completion for each insurance that is less than $90.
When sending the insurance company quotes form, instruct the applicant to ask the companies the questions on the form, write down the insurance companies' answers and return the forms.  Tell the applicant the insurance companies DO NOT need to provide anything in writing or sign the form.  Upon receipt of the completed forms, the worker will determine whether the insurance meets the definition for affordable health insurance.

Copy the attached form as needed.  The form is not available through the warehouse at this time.
NECESSARY ACTION:
  • Share this memorandum with staff.
  • Begin using the revised IM-1UA upon receipt.
  • Begin using the MC+ Insurance Company Quotes form when needed.
  • File the revised IM-1UA and instruction page 3 in the IM Forms Manual.
MJS
Distribution #2
Attachment not available online.
Refer to hard copy.
[ 1999 Memorandums ]