Edit MO Employer Sponsored Coverage

If a household member indicates s/he is enrolled in Employer Sponsored Insurance (ESI), evidence is created for the MO Employer Sponsored Coverage. If the ESI plan changes, use the following to end date MO Employer Sponsored Coverage evidence and create new evidence.

By policy, SMHB eligibility is granted as continuous coverage. However, if you enter a CiC that enrolls the participant in, or grants access to insurance that covers all three phases of maternity services, MEDES will end SMHB coverage. If this happens, follow the steps in Adding MO Override Eligibility Evidence to grant SMHB coverage through the applicable end date.

Evidence: MO Employer Sponsored Coverage

TO EDIT MO EMPLOYER SPONSORED COVERAGE

    1. Navigate to the Integrated Case > Evidence sub-tab > Dashboard folder
    2. Click the MO Employer Sponsored Coverage hyperlink
    3. In the MO Employer Sponsored Coverage window, enter the date the insurance policy ended in the Policy End Date field
    4. Click Save
    5. Follow the steps in the Add Employer Sponsored Coverage User Guide to add the new Employer Sponsored Insurance information if applicable
    6. Verify all Outstanding Evidence
    7. Apply Changes, Check Proposed Determination, Finalize Proposed Determination

NOTE: MEDES may generate an additional proposed determination, especially in cases with income changes, adding a person, or removing a person. If the system generated an additional proposed determination, you must run the Finalize Proposed Determination again

    1. Make a comment on the HoH Person Page to include:any Coverage Changes
    2. Review Notice Queue to make sure appropriate forms generated
      1. IM-80: Generates in the event of coverage changes
      2. IM-33C: Case Action Notice