Check Eligibility of an Application Case

An Eligibility Check must be ran prior to approving the Application Case to ensures MAGI policy is correctly applied.

As part of Release 2.2, MEDES will attempt to call the Federal Hub (H-31) to check for any federal non-employer sponsored minimum essential coverage (MEC) at the time of Check Eligibility. The Hub will only be called for participants who:

  • Are requesting coverage
  • Provide an SSN
  • At least one member of the household is seeking benefits
  • A call was not already made for that person

TO CHECK ELIGIBILITY ON AN APPLICATION CASE

    1. Navigate to the Application Case > Eligibility Checks sub-tab
    2. Click the Check Eligibility… Wizard
    3. Click Yes Yes Button
    4. in the Check Eligibility request

NOTE: All members must have DCN assigned before a manual eligibility check can be performed. If DCNs are not assigned, you will receive a warning message. See Transfer DCN to MEDES for step-by-step instructions on how to assign a DCN.

    1. Toggle open to review health benefit(s)

NOTE: There can be multiple Eligibility Checks showing. The most current Eligibility Check is at the top of the list.