1. Is there a separate application for the MCHA Healthy Minnesota Contribution Program?

Transcription

1 Minnesota Comprehensive Health Association (MCHA) - Frequently Asked Questions & Answers about the MinnesotaCare Healthy Minnesota Contribution Program MCHA Healthy Minnesota Contribution Program Materials 1. Is there a separate application for the MCHA Healthy Minnesota Contribution Program? A. Yes, there is an abbreviated application, which was created just for the MCHA Healthy Minnesota Contribution Program applicants. The application is titled MCHA Healthy Minnesota Contribution Program Application (MinnesotaCare recipients only). The form # is COM How do individuals locate the MCHA Healthy Minnesota Contribution Program application and benefit summary materials? A. Individuals can access materials on the MCHA website at mchamn.com (choose Applications and Forms, and locate application under Deductible Plans ). Upon request, MCHA Customer Service ( ) can send out hard copies of the application. Medica-appointed agents can get information online by going to On the home page, choose Brokers and then Commercial Plans. You will reach a Login screen, which will ask your username and password. If you are a first-time user, please go to the Broker Registration Form to set-up a username and password. Once you are logged in, choose Sales Materials (left menu) and select Applications/Forms or Brochures to locate MCHA materials. Choose Applications and Forms and then select Minnesota, Enrollment and Changes and MCHA. Choose Brochures and select MCHA for brochures, and rate sheets. MinnesotaCare and the Healthy Minnesota Contribution Program 1. What is MinnesotaCare? A. Publicly subsidized health insurance plan providing working people, who are between % of the Federal Poverty Guidelines, with financial assistance for health care services. 2. How does MinnesotaCare work? A. Individual must complete a 16 page application answering income and asset questions. Completed applications are directed to a county office or mailed to the Department of Human Services in St. Paul, MN. 3. What is the Healthy Minnesota Contribution Program? A. Legislation passed in 2011 [sec. 73. (256L.031)] to move individuals into private insurance plans and provide coverage for catastrophic care (previous benefit limit for care was $10k) as of July 1, What are the requirements of the Healthy Minnesota Contribution Program? A. Must be without coverage for at least four months prior to qualifying; cannot be pregnant; cannot have children under age 21 living with them; does not qualify if employer offers coverage and pays at least 50% of the premium. 1

2 5. What is the Healthy Minnesota Contribution Program eligibility period? A. The eligibility period is four (4) months from date of first eligible for the program. Example: If eligible July 1, client will get a letter in June and they have until the end of October to apply with a carrier. See question # 8. (below), for a clarification regarding the effective date for the MCHA Healthy Minnesota Contribution Program. 6. If the application is received after the Healthy Minnesota Contribution Program eligibility period [four (4) month eligibility period] and denied can the person file an MCHA/Medica appeal? A. No. The Minnesota Department of Human Services administers the Healthy Minnesota Contribution Program and dictates the program eligibility guidelines. Concerns should be directed to the MN Department of Human Services at or (TTY call through the Minnesota Relay at ). Callers are asked to leave a message. The goal is to return calls within 24 hour. 7. What happens if the applicant submits a standard MCHA application instead of the MCHA Healthy Minnesota Contribution program application? A. The Eligibility Analyst will return the incorrectly completed application and will enclose the correct MCHA Healthy Minnesota Contribution Program application, requesting completion/return within 10 business days. If the correct application is returned within the 10 days, or just following the end of the Healthy Minnesota eligibility period, the Eligibility Analyst is able to review and process the application. 8. What are the eligibility criteria for the MCHA Healthy Minnesota Contribution program? B. If the individual is denied in the private market or has a presumptive condition they can apply for the MCHA Healthy Minnesota Contribution Program. An eligible applicant must provide a copy of their Healthy Minnesota Contribution Program approval notice from the MN Department of Human Services within the four (4) month eligibility period. 9. What is the Healthy Minnesota Contribution Program approval notice? A. If an individual qualifies for the Healthy Minnesota Contribution Program, the MN Department of Human Services will provide them with an approval notice. This notice will include an individual account number, effective date and the amount of contribution. 10. What is the effective date for the MCHA Healthy Minnesota Contribution Program? A. If coverage is offered, the effective date of coverage is the first day of the month following receipt of a completed application (including required documentation and premium payment); if received within the four (4) month eligibility period as defined by the Healthy Minnesota Contribution Program. See the MCHA Healthy Minnesota Contribution Program Application section E. Eligibility for this same definition. Clarification - If an application is received and approved during the fourth month (last month) of the eligibility period, the effective date is still the first day of the following month. 11. Are dependent eligible for the MCHA Healthy Minnesota Contribution Program? A. No. The MCHA Healthy Minnesota Contribution Program is offered to individual applicants. Dependents are not eligible. Family members will need to request separate program eligibility. 12. What resources are available to help individuals seek Healthy Minnesota Contribution Program eligibility and plans offered in the private market? A. Resources to help explore MinnesotaCare and the Healthy Minnesota Contribution Program plan options: Minnesota Agents Coalition Referral Site at 2

3 3 Log onto the MN Department of Human Services Web site at - click on Health Care. Call the MN Department of Human Services Information Desk (Healthcare Access Line) at or (TTY call through the Minnesota Relay at ). Callers are asked to leave a message. The goal is to return calls within 24 hours. Contact county human service office (refer to the last page) Completing the MCHA Healthy Minnesota Contribution Application 1. Who does the applicant contact regarding MCHA Healthy Minnesota Contribution Program application inquiries or to check on the status of an application? A. Applicants contact MCHA Customer Service at, Hearing impaired call the National Relay Center at and ask for the number above. Agents contact the MCHA/Medica Service Center Department at or toll free at Does the applicant have to fill out all the sections of the application? A. Yes, The application identifies the sections that must be fully completed. Please refer to the application sections that note Required Information. Section F. Agent Information, must be completed for agent assisted applications. 3. Where can applicant find plan coverage information to complete application section A. Plan Options? A. All MCHA plans are offered. Plan benefit summaries are located on the MCHA website at (choose Benefit Plans ). Upon request, MCHA Customer Service ( ) can send out hard copies of the benefit summaries. 4. When completing application section B. Applicant Information, can applicant include dependents? A. No. The MCHA Healthy Minnesota Contribution Program is offered to individual applicants. Dependents are not eligible. Family members will need to request separate program eligibility and complete their own applications. 5. Within Section D. Premium Payments, what is the Account Number? A. Upon qualifying for the Healthy Minnesota Contribution Program, the Minnesota Department of Human Services issues the individual a unique account number. This number is included on the approval notice. This number should be included on the MCHA application. If the applicant has not received an approval notice they should contact the Minnesota Department of Human Services at or (TTY call through the Minnesota Relay at ). Callers are asked to leave a message. The goal is to return calls within 24 hours. 6. Within Section D. Premium Payments, what Amount $ should the applicant include? B. The amount to include is found on the Healthy Minnesota Contribution approval notice they received from the Minnesota Department of Human Services. There should be two different contribution amounts shown on this notice. The first monthly contribution amount applies to coverage received in the private market. The second monthly contribution amount applies to coverage received through the Minnesota Comprehensive Health Association (MCHA). The contribution amount for MCHA coverage is increased 20%, because MCHA premiums cost more. Applicant should include, on the application, the contribution amount noted for MCHA. If applicant has not received an approval notice, please direct them to the Minnesota Department of Human Services at or (TTY call through the

4 4 Minnesota Relay at ). Callers are asked to leave a message. The goal is to return calls within 24 hours. 7. Within Section E. Eligibility, what is the effective date of coverage? A. Application must be received within the four (4) month eligibility period as defined by the Healthy Minnesota Contribution Program. If application is approved, the effective date of coverage is the first day of the month following receipt of a completed application (including required documentation and premium payment). 8. What are the eligibility criteria options for the MCHA Healthy Minnesota Contribution Program? A. Eligibility options include Evidence of Rejection (from individual health insurance carrier or agent certification of rejection) or Presumptive Condition(s). 9. What if applicant doesn t fill out the application section H. Check List? Will MCHA deny the application? A. The application will not be denied. However, we have identified this section as Required Information because the MCHA application process can be complicated, and reviewing the Check List will help to assure all necessary sections of the application are completed and necessary supporting documentation is included. Incomplete applications that do not include all the necessary information and documentation will pend for up to 30 days, awaiting the required information. This may delay the effective date of coverage and to qualify a completed application must be received within the four (4) month eligibility period as defined by the Healthy Minnesota Contribution Program. 10. Can an agent write the evidence of rejection or does applicant need something from an insurance carrier? Does applicant need to actually apply with another carrier, or will MCHA take the agents word that no insurance carrier will provide individual coverage? A. A Minnesota licensed health insurance agent can certify Evidence of Rejection by completing the Agent Certification of Rejection information within section F. Agent Information on page 2 of the application. The "Agent Certification of Rejection" is required if the applicant is applying under section E. Eligibility : 1. Evidence of Rejection (b). Agents should complete within section F, the Agent Certification of Rejection instead of including a letter with information on the applicant s market plan rejection. This section of the application requires the following information: reason for rejection or medical condition, name and address of Insurer or Health Maintenance Organization (HMO) licensed to sell health coverage in Minnesota that will NOT accept the applicant. 11. What fee does the agent receive if they assist the applicant with completing the MCHA Healthy Minnesota Contribution Program application? A. If an agent assists an individual with completing an approved application, they receive a one time $50 fee. 12. Does the application need to be signed and dated by the applicant? A. Yes, the application must be signed on page 3 (sections G. Applicant s Disclosure Authorization and Declaration, and section H. Check List ). Please also note that within section G. Applicant s Disclosure Authorization and Declaration, the applicant s initials are required for each disclosure statement. Applicant should be certain all sections are fully completed. 13. Does applicant need to send a premium payment with the application? A. Yes. If the Healthy MN Contribution amount does not cover the full premium amount due, the applicant must include a check or money order for their appropriate portion of the monthly premium made payable to MCHA. To determine this amount, see the MCHA Healthy Minnesota Contribution Program premium rate sheet; find the full amount due and subtract the Healthy Minnesota Contribution Program

5 amount. Applications will pend if appropriate premium amounts are not submitted with the application. This may delay the effective date of coverage. Reminder - all needed information must be received, to approve the application, within the Healthy Minnesota Contribution Program four (4) month eligibility period. 14. How is applicant informed that an application is pended requiring additional information? How does applicant resolve the pended issue? A. If an application is incomplete, a pending letter is sent to both the applicant and the agent. The required information to process the application should be submitted within 30 days from the date on the MCHA pend letter. When submitting the missing information, applicant should include a copy of the original MCHA pending letter. This will allow the application to be processed more quickly. Reminder - all needed information must be received, to approve the application, within the Healthy Minnesota Contribution Program four (4) month eligibility period. 15. If additional information is needed to process an application, how long is the MCHA application pending period? A. The application will pend for 30 days. An application is not considered complete until all necessary information is received. Reminder - all needed information must be received, to approve the application, within the Healthy Minnesota Contribution four (4) month eligibility period. If a response is not received or adequate information is not received the application will not be processed and will be returned. Request to Backdate the MCHA Effective Date 1. Once enrolled in MCHA, through the Healthy Minnesota Program, can the policyholder backdate their effective date of coverage if there is a lapse between the termination of previous MinnesotaCare coverage and the effective date of MCHA coverage? A. Yes. Policyholder must submit to MCHA a Healthy Minnesota Contribution Program Request to Backdate Coverage Form. If eligible and approved, the new effective date will be the date following termination of Minnesota Care coverage (1st of the month and no more than 90 days before the original MCHA application approval date). 2. How do individuals locate the MCHA Healthy Minnesota Contribution Program Request to Backdate Coverage Form? A. Individuals can access the form on the MCHA website at mchamn.com (choose Applications and Forms, and locate form under Miscellaneous Forms ). Upon request, MCHA Customer Service ( ) can send out a hard copy of the form. 3. What criteria must be met to request a new backdated effective date of coverage? A. To make a request, policyholder must: Complete and submit a Healthy Minnesota Contribution Program Request to Backdate Coverage Form; Have applied for MCHA coverage within 90 days following the MinnesotaCare termination date; Submit the request form no more than 90 days from the original MCHA approval date; Be a resident of Minnesota and provide proof of this for the six month period prior to the date MCHA received the original application; Pay correct policyholder portion of the monthly MCHA premium for the backdated month(s) 5

6 4. What documentation must be included with the Healthy Minnesota Contribution Program Request to Backdate Coverage Form? A. Required documentation includes: A copy of the MinnesotaCare termination notice; A copy of a document showing Minnesota residency (acceptable documents listed on request form); A check or money order for correct policyholder portion of premium for the additional month(s) of coverage Pre-Existing Condition Waived 1. Is there a Pre-existing Condition Limitation with MCHA? A. No. The MCHA Healthy Minnesota Contribution policy provides benefits for pre-existing conditions due to a legislative requirement. 6 Premium Payment/Premiums 1. What are the rates for the MCHA Healthy Minnesota Contribution Program? A. The rates are provided on the MCHA Healthy Minnesota Contribution premium rate sheet. Please direct the appropriate rate sheet to applicants, since this rate sheet does not include dependent rates (dependents are not eligible for this program). Rates are the same as the monthly premium rates for MCHA s regular plans. 2. Are there standard (non-tobacco use) and tobacco premium rates? A. Yes, policyholder pays the MCHA standard premium rates or MCHA tobacco-user premium rates based on the policyholder s use of tobacco as identified on the application. 3. Is there a quarterly billing option available? A. No. The Minnesota Department of Human Services only pays a monthly contribution amount for the policyholder. 4. How does the applicant know their Healthy Minnesota Contribution Program premium contribution amount? A. Upon qualifying for the Healthy Minnesota Contribution Program, the Minnesota Department of Human Services issues the individual an approval notice. The approval notice includes their premium contribution amount. This amount is a variable and can change do to age or income changes. It s the responsibility of the individual to keep track of contribution amount changes and their needed MCHA premium amounts. 5. Does applicant need to send in a check with the application? A. Yes, if their Healthy Minnesota Contribution Program contribution amount does not cover the entire monthly premium due. The Healthy MN Contribution Program amount is listed on the approval notice they received from the Minnesota Department of Human Services. The applicant should take the full MCHA monthly premium, for their chosen plan option, minus Healthy Minnesota Contribution amount to determine their premium check amount. If premium is due, a check should be made payable to MCHA and included with the application. Applications will pend if appropriate premium amounts are not included with the application and may delay the enrollment effective date.

7 6. What premium payment information is required on the MCHA Healthy Minnesota Contribution Program application (section D. Premium Payments)? A. Applicant must include their account number, program effective date and contribution amount from their Healthy Minnesota Contribution Program approval notice. 7. Who does applicant/policyholder make the check out to and where is it sent? A. Make check payable to: MCHA Send check to: MCHA/Medica Mail Route MN Rice Lake Road Duluth, MN Is there an ACH (Automated Clearing House) premium payment option? A. No. Policyholders are responsible for knowing their own premium payment amount based on their Healthy Minnesota Contribution Program amount, which can change based on income and age. MCHA is not able to request the contribution amount, from the Department of Human Services, until the policyholder pays their correct premium amount. 9. Why can t I fax the application so you can start processing the application and we will send the check separately? A. Applications and all required documentation (Healthy Minnesota Contribution Program approval notice) including any applicable premium payment should be directed to MCHA at the same time. Applications received without all information (per Minnesota Statute) are considered to be incomplete and therefore will be pended until all information is received. 10. Why can t MCHA issue the policy if the premium check amount is incorrect? We ll send the money later. A. The applicant must pay the full MCHA monthly premium, minus the Healthy Minnesota Contribution amount. This amount is needed before MCHA can request the Healthy Minnesota Contribution amount from the MN Department of Human Services. 11. When are MCHA Healthy Minnesota premium bills sent to policyholders? A. Premium bills are generated and mailed around the 20th of the month. 12. When is the Premium due? A. Premium is due on the first day of the month; however, the full premium amount is due within the 30 day grace period (generally before the end of the month) for coverage to remain in force. 13. When will MCHA receive the Healthy Minnesota Contribution amount? A. MCHA will not receive the Healthy Minnesota Contribution amount until the policyholder s premium portion has been paid. Therefore, it s important that the policyholder s premium portion is received by MCHA well before the grace period ends. 7

8 Termination of coverage 1. Where can I find information regarding termination of coverage? A. The MCHA Healthy Minnesota Contribution Policy of Coverage document describes when coverage ends within section CC. Ending Coverage. Coverage will end the end of the month for which the enrollee last paid their appropriate portion of the premium due or the date the Healthy Minnesota Contribution Program no longer provides a premium contribution. 2. If a policyholder is terminated because they no longer qualify for the Healthy Minnesota Contribution Program, can they continue coverage and pay the full premium amount due? A. No. If they are no longer eligible for the Healthy Minnesota Contribution Program amount, as determined by the Dept of Human Services, they are terminated from the MCHA Healthy Minnesota Contribution Program. To move to regular MCHA coverage, they must complete the standard MCHA application and meet the standard MCHA eligibility requirements. If accepted under the regular MCHA coverage any previously accumulated deductible/out-of-pocket amounts will roll to the new plan coverage. The deductible/out-of-pocket amounts will reset on January If a policyholder is terminated from the Healthy Minnesota Contribution Program and they reapply for standard MCHA coverage, will they receive a pre-existing condition limitation waiver and what will be their effective date of coverage? A. They must complete a standard MCHA application and meet the standard MCHA eligibility requirements. To request a waiver of the pre-existing condition limitation, they must apply within 90 days of the termination of their prior Healthy Minnesota Contribution Program coverage. If a pre-existing condition limitation waiver is requested and approved, the effective date of coverage will be backdated to the day following termination of the prior coverage. Benefits 1. Are the benefits offered to the Healthy Minnesota Contribution Program policyholders the same as the benefits offered through the regular MCHA plans? A. MCHA offers the same benefit plan options to Healthy Minnesota Contribution Program policyholders. However, the MCHA Healthy Minnesota Contribution Program includes a limited abortion benefit exclusion per legislative requirements [sec. 73. (256L.031)]. See the Policy of Coverage document section Y. Exclusions, number 63. Abortion services except where the life of the female would be endangered or substantial and irreversible impairment of a major bodily function would result if the fetus were carried to term; or where the pregnancy is the result of rape or incest. 8

9 COUNTY HEALTH CARE PROGRAM TELEPHONE NUMBERS AITKIN MARSHALL ANOKA MARTIN BECKER MCLEOD BELTRAMI MEEKER BENTON MILLE LACS BIG STONE MORRISON BLUE EARTH MOWER BROWN MURRAY CARLTON NICOLLET CARVER NOBLES CASS NORMAN CHIPPEWA OLMSTED CHISAGO OTTER TAIL CLAY PENNINGTON CLEARWATER PINE COOK PIPESTONE COTTONWOOD POLK CROW WING POPE DAKOTA RAMSEY DODGE RED LAKE DOUGLAS REDWOOD FARIBAULT RENVILLE FILLMORE RICE FREEBORN ROCK GOODHUE ROSEAU GRANT ST. LOUIS Duluth: Virginia: Hibbing: Ely: HENNEPIN SCOTT HOUSTON SHERBURNE HUBBARD SIBLEY ISANTI STEARNS ITASCA STEELE JACKSON STEVENS KANABEC SWIFT KANDIYOHI TODD KITTSON TRAVERSE KOOCHICHING WABASHA LAC QUI PARIE WADENA LAKE WASECA LAKE OF WOODS WASHINGTON LESUEUR WATONWAN LINCOLN WILKIN LYON WINONA MAHNOMEN WRIGHT YELLOW MEDICINE