Add MO Insurance Policy Details Evidence

If a household member is covered by an insurance plan which is not employer sponsored, such as Medicare, evidence is created on the MO Insurance Policy Details screen. Use the following to add MO Insurance Policy Details 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.

 

Applicants with active Medicare are not eligible for UWHS. MO Insurance policy details must be entered with both family planning service questions answered yes, for the eligibility system to recognize that the individual is insured and not eligible for UWHS. If the UWHS eligibility is still showing in the system, contact the MEDES Help Desk.

 

TO ADD MO INSURANCE POLICY DETAILS

    1. Navigate to the Integrated Case/Application Case > Evidence sub-tab > Dashboard folder
    2. Hover your mouse over MO Insurance Policy Details until the Create Evidence icon appears
    3. Click the Create Evidence icon
    4. Enter the Received Date. The received date should match the date the FSD received the evidence from the participant
    5. Select the participant covered under the Non-ESI coverage from the Participant drop down menu
    6. Select the type of private insurance from the Insurance Type drop down menu
    7. Select the policy holder from the Policy Holder drop down menu
      1. If the policy holder is not in the participant’s household, complete the information below the Policy Holder drop down menu instead of selecting from the list
    8. Enter the date the policy started in Policy Start Date
    9. Enter the premium for the selected participant in the Premium Amount field
    10. Enter the name of the insurance company in the Company Name field
    11. Answer Family Planning Services questions from the Family Planning Services drop down menus
    12. Answer maternity services questions from the Maternity Services drop down menus.
    13. Click Save
    14. AC Cases, continue with the 03 Processing an Application Case.  IC Cases continue to step 15.
    15. Verify all Outstanding Evidence
    16. 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-80PRE: Generates in the event of coverage changes that result in a complete loss of coverage.
      2. IM-80: Generates in the event of negative coverage changes
      3. IM-33C: Case Action Notice