To qualify for MO HealthNet under the Children's Health Insurance Program (CHIP) (income above the non-CHIP Group maximums) a child must be uninsured and household income must be above 148% and below 300% of the Federal Poverty Level (FPL).
CHIP children receive full, comprehensive MO HealthNet coverage including primary, acute and preventative care, hospital care, dental and vision care as well as prescription coverage.
EXCEPTION: Non-emergency medical transportation is not provided to Premium group children (CHIP 73, 74 and 75).
SB 632 enacted changes effective September 1, 1998 providing Title XIX coverage to uninsured children with family income over the previous limits up to 300% of the federal poverty level (FPL). The bill required cost sharing for higher income families in the form of co-payments and premiums. Children's Health Insurance Program funds (Title XXI of the Social Security Act) and premium collections provide funding for this expansion of health care benefits.
Senate Bill 539 (2005) enacted changes effective September 1, 2005 to the MC+ for Kids healthcare coverage program (CHIP). The bill lowered the income limit for no-cost coverage and eliminated all cost-sharing except premiums. Under SB 539, uninsured children are divided into two eligibility groups:
Missouri Revised Statutes, Section 208.640 limits premiums and other cost-sharing to no more than 5% of a family's income. House Bill 11 (2005) limits premiums to:
Senate Bill 577 (2007) enacted changes to the MO HealthNet CHIP program. The bill allowed for uninsured children in families with gross income up to 150% FPL to meet all Title XIX program guidelines as defined under Optional Targeted Low Income Children (Social Security Act 1902(a)(10)(A)(ii)). This allows :
Effective January 1, 2014, the Patient Protection and Affordable Care Act (PPACA or more commonly called the ACA) of 2010 requires Family MO HealthNet programs to use Modified Adjusted Gross Income (MAGI) methodology. The ACA removed net worth as a requirement.
All eligibility requirements in section 1805.000.00 must be met in addition to the following:
In addition to the above criteria, children in the premium groups must:
NOTE: A pregnant child (individual under age 19) must be determined ineligible for the non-CHIP group (MHK), CHIP 71 and 72, and the MO HealthNet for Pregnant Women (MPW) program prior to approval for Show Me Healthy Babies (SMHB) coverage. Refer to 1855.020.70 Ineligible for any other MO HealthNet Programs for more information on pregnant children who meet CHIP 73, 74 or 75 income standards.
CHIP children are divided into four eligibility groups according to their household income based on MAGI Methodology:
Per Missouri State Statue, RSMo Section 208.631.1, health care must be made available to uninsured children whose household income falls within any of the CHIP groups (premium or non-premium), 150% to 300% of the FPL.
NOTE: Prior to July 1, 2014 children must have been uninsured for six (6) months. Senate Bill 754 (2014) removed the penalty for dropping insurance for both premium and non-premium CHIP groups.
Uninsured children are defined as any person up to nineteen years of age and:
NOTE: Uninsured children must also meet Missouri residency requirements as well as all other financial and non-financial MO HealthNet eligibility criteria.
A child covered by health insurance at the time of CHIP eligibility is considered ineligible unless the insurance is one of the following:
NOTE: Persons who have exceeded an annual or lifetime maximum for all coverage under their plan are considered uninsured. The applicant/participant must provide verification from his or her health plan that the child has reached the annual/lifetime maximum for all plan coverage. The verification must provide a date if healthcare coverage will be reinstated for the child. The E ligibility Specialist must update the evidence in MEDES annually.
NOTE: A disabled child who is eligible for non-spend down MO HealthNet for Disabled Children (MHDC) is considered insured and is ineligible to receive CHIP coverage. A disabled child who is eligible for spend down MHDC is considered uninsured and would be potentially eligible for CHIP coverage.
To determine insurance affordability refer to MAGI Policy Manual sections 1840.010.15 Access to Affordable Health Insurance and 1840.010.15.05 Affordable Insurance Definition.
Individuals insured simply because the Health Insurance Premium Payment (HIPP) program is paying the premium will be treated as though they are uninsured. If a child in the Non-CHIP group has insurance through HIPP, and a change in income occurs that changes the child’s eligibility to one of the CHIP groups, the child continues to be eligible for MO HealthNet as though uninsured.
NOTE: Health Insurance available to children of state employees is considered affordable. See section 1840.010.15.10
In addition to being uninsured, Premium group children (income above 150% of FPL) (CHIP73, CHIP74, and CHIP75) cannot have access to affordable health insurance. Access to affordable insurance available through employment, a group membership, or from a private company causes ineligibility. Examples of group memberships that could offer health insurance are a union, professional organization, or trade association.
NOTE: If an individual does not meet the workplace or group membership criteria to be eligible for employer sponsored or group membership insurance at the time of application, such as hours worked or length of membership, then the insurance is not available to that person. It is the participant's responsibility to report any changes that could affect his or her eligibility within ten days of the change.
If the household fails to purchase the affordable health insurance, premium group children are ineligible as long as it is available. It is considered available even though there is a limited open enrollment period for which they need to wait.
EXAMPLE: In July, Ms. Marks applies for MO HealthNet for Kids (MHK) for her children. Her gross income places coverage within the Premium Group. Ms. Marks has been employed since February, and chose not to enroll her children in employer sponsored insurance that is considered affordable. Her employer offers open enrollment every October with coverage beginning in January. Ms. Marks has access to affordable health insurance and is not eligible for MHK coverage.
Senate Bill 577 (2007) modified 208.640 RSMo to provide that employer sponsored health insurance and other health insurance that does not cover an eligible child’s pre-existing conditions is not considered affordable health insurance. The applicant/participant must provide verification from the:
Additionally, Senate Bill 577 (2007) modified 208.640 RSMO to provide that an eligible child who has exceeded the annual coverage of his or her health plan for all healthcare services, is considered uninsured and does not have access to affordable health insurance.
The affordability standard, outlined in RSMo Section 208.640, is based upon a percentage of income for a household of three at 150% (CHIP73), 185% (CHIP74), or 225% (CHIP75) of the FPL, depending upon the household’s gross income.
Households with income between 150% and 300% of the FPL with access to insurance must meet the following affordability guidelines:
NOTE: The affordability standard is updated each April if there are changes in the Federal Poverty Level.
NOTE: Consider all health insurance through employment with state agencies, where health insurance is available to their employees, as affordable regardless of the cost of the health insurance as compared to the affordability standards. See NOTE in Section 1840.010.10.05. If the state employee is receiving premium assistance through the HIPP program, they still have access to affordable insurance and are ineligible for all CHIP premium levels of coverage.
If insurance is available for the child(ren) at a cost below the affordability standards, the child(ren) is not eligible for the MO HealthNet for Kids CHIP Premium coverage due to access to affordable health insurance. Refer to Section 1840.010.3, if the child(ren) has a pre-existing condition that the health insurance plan does not cover, or if the child(ren) has exceeded annual coverage for all healthcare services.
It is required that CHIP cases explore the potential for private affordable health care coverage prior to approval, outlined in 1840.010.15.05 Affordable Insurance Definition.
FSD will determine affordability using the CHIP Affordability Calculator. The calculator will compare CHIP premium amounts to insurance premium amounts on the FFM to determine affordability based on the size of the household and the region of the state they live in.
The individual can choose to provide an insurance quote if that is their preference but do not request them to provide insurance quotes since FSD can make the affordability determination using the calculator.
NOTE: Individuals will still be required to provide employer sponsored insurance quotes when applicable.
Undocumented aliens are not insurable. Do not ask for private insurance quotes for undocumented aliens.
Individuals may research quotes during closed and open enrollment periods at www.healthcare.gov, but FFM coverage can only be purchased during the annual open enrollment period. Private insurance is considered available during open, closed, and special enrollment periods.
NOTE: The open-enrollment dates changes yearly. See www.CMS.gov to view the current enrollment period.
Closed enrollment period:
Open enrollment period:
Special enrollment period:
CHIP Affordability Test:
NOTE: Compare the CHIP Premium to the FFM Highest Gold Premium. If it is more than the CHIP premium, no affordable insurance is available.
Employer sponsored health insurance causes ineligibility if:
EXAMPLE: Mrs. Maple applied for MO HealthNet for Kids for her daughter Ann. The Maple family income is over 150% of the federal poverty level (CHIP premium level). Ann does not have health insurance. Mr. Maple has employer sponsored insurance that would cover Ann if he elected to cover her, but it will not cover her asthma, a pre-existing condition. Mrs. Maple provided a letter from Ann’s physician stating that Ann has asthma. She also furnished Mr. Maple’s health insurance member handbook that verifies that pre-existing conditions are not covered. Since Ann is uninsured and Mr. Maple’s employer sponsored health insurance will not cover Ann’s asthma, Ann does not have access to affordable employer sponsored health insurance. FSD staff processing the application must use the Affordability Calculator to determine if affordable insurance is available to this family. DO NOT require the family to provide insurance quotes unless they disagree with the Calculator determination. If that occurs, they may provide quotes verbally or in writing at an FSD office or through the FSD Information Center at 1-855-FSD-INFO (1-855-373-4636).
EXAMPLE: Mrs. Davis applied for MO HealthNet for Kids for her daughter Julie. Mr. Davis just purchased employer sponsored health insurance for Julie, and then learned that her asthma will not be covered because it is a pre-existing condition. The Davis family income is over 150% of the federal poverty level (CHIP premium level). Julie has health insurance, but it does not cover her pre-existing conditions. Because Mr. Davis’ employee insurance will not cover Julie’s pre-existing condition she is eligible for MO HealthNet for Kids, CHIP premium level of care, even though she is an insured child. Third Party Liability (TPL) information must be submitted to MO HealthNet Division regarding Mr. Davis’ insurance.
If an individual does not meet the workplace criteria to be eligible for employer insurance at the time of application, such as hours worked or length of time with the company, then the insurance is not available to that person. It is the participant's responsibility to report any changes that could affect his or her eligibility within ten days of the change.
Health insurance available to a state employee through a state agency is considered affordable regardless of cost. If the state employee is receiving premium assistance through the HIPP program, they still have access to affordable insurance and are ineligible for all CHIP premium levels of coverage.
Section 2110(b)(2)(B) of the Social Security Act (SSA) states children who have a family member eligible for health benefits coverage under a State health benefits plan on the basis of the family member's employment with the State are not eligible for the Children's Health Insurance Program (CHIP).
EXAMPLE: The Missouri Department of Transportation (MoDOT) is a state agency that does not participate in Missouri Consolidated Health Care Plan (MCHCP), however, provides health insurance to their employees.
An applicant with two children applies for Family MO HealthNet and works part-time for MoDOT. The expense of purchasing the MoDOT health insurance is $300.00 per month and therefore, the applicant chose not to purchase the insurance. The applicant's household is uninsured. The applicant is a state employee who can purchase health insurance through their state employer. The children are not eligible for CHIP level of care.
NOTE: Section 2110(b)(2)(B) of the SSA does NOT apply to non-CHIP Family MO HealthNet cases.
Not all individuals working for a state agency may be eligible to receive or purchase health benefits coverage under a State health benefits plan. Some temporary employees, part time employees, and others may not be eligible to purchase health insurance through a state agency and should not be considered to have access to health benefits coverage under a State health benefits plan.
If affordable employer sponsored insurance is not available, evaluate access to affordable private insurance coverage. FSD must refer to the Affordability Calculator to see if affordable insurance is available. DO NOT require the family to provide insurance quotes unless they disagree with the calculator determination. If the family disagrees, they may give quotes verbally or in writing at a FSD office or through the FSD Information Center at 1-855-FSD-INFO (1-855-373-4636).
NOTE: Written verification from insurance companies is not required, but the applicant must supply names of the insurance companies.
NOTE: Undocumented immigrants do not have access to affordable insurance, as they cannot purchase an insurance plan through the Federally-Facilitated Market Place at www.Healthcare.gov.
A private insurance policy causes ineligibility if it:
If the private insurance quotes are above the affordable amount, the family does NOT have access to affordable insurance and the children are eligible on that factor. If one or both of the private insurance quotes are less than the affordable amount, the family has access to affordable insurance and the children are not eligible for CHIP premium coverage.
Effective July 1, 2004, RSMo. 208.647 eliminated the 30-day waiting period in the CHIP75 Premium Group for children with special healthcare needs that do not have access to affordable employer sponsored health insurance.
Special healthcare needs are defined as a medical condition which left untreated would result in the death of or serious physical injury to a child. Self attestation may be accepted for special healthcare needs.
Evaluate the special healthcare needs exception when:
Affordable employer sponsored healthcare is defined in Sections 1840.010.15 and 1840.010.15.10. Children in any of the premium groups (income above 150% FPL) are ineligible if they have access to affordable health insurance, private or employer sponsored. (Refer to Section1840.010.15).
MO HealthNet eligibility and coverage for children in the No-Cost group (CHIP71 and CHIP72) begins with the first day of the month of application or first day of the month in which eligibility is met.
NOTE: Children in the No-Cost group are eligible for prior quarter determination.
For children in the Reduced Premium group (CHIP73 and CHIP74) MO HealthNet eligibility begins on the date of application, or first day of the month determined eligible. Coverage begins on the date of application or first day of the month determined eligible, or the date the premium is paid, whichever is later.
NOTE: Children in the Reduced Premium group are not eligible for prior quarter coverage.
For eligible children in the Full Premium group (CHIP75), eligibility and coverage can begin no earlier than 30 days from the date of application, or on the date the premium is paid, whichever is later. For eligible (CHIP 75) premium group child(ren) determined to have special healthcare needs, eligibility begins on the date of application and coverage begins on the date of application or the date the premium is paid, whichever is later. The exception to the 30-day waiting period only applies to the child(ren) with special healthcare needs; other children in the household who do not have a special healthcare need are subject to the 30-day waiting period from the date of application.
EXAMPLE: Mrs. Wilson applies for MO HealthNet for her one child, Jan, on September 1. She meets all eligibility requirements for the Full Premium Group (Level of Care 3, CHIP75). Mrs. Wilson attests that Jan has special healthcare needs. The eligibility specialist approves the case September 10. As Jan has special healthcare needs, there is no 30-day waiting period for eligibility from date of application, eligibility begins September 1.
An invoice is mailed to Mrs. Wilson on September 11, the day after the approval. Mrs. Wilson's payment is received by the MHD Stakeholder Services Unit on September 15. Jan's coverage begins September 15.
NOTE: Children in the Full Premium group are not eligible for prior quarter coverage.
MO HealthNet coverage for all CHIP children is date specific at the time of closing. An adverse action notice must be sent. Close the coverage on the first business day following the expiration of the adverse action.
Changes in a household's circumstances may cause a family to be eligible for a different premium amount or level of care (LOC).
Occasionally, a change in household composition could result in an increase or decrease in the premium amount. The premium may increase in situations where a person is added to an existing household, but the income and federal poverty level percentage remain in the same category.
CHIP premiums are also updated every July 1st. Refer to the MO HealthNet for Kids - CHIP Premium Chart at Appendix E, Section 1800.000.00.
NOTE: Whenever a premium increases, the participant must be sent an Adverse Action Notice (IM-80) and an Action Notice (IM-33C) to advise the participants that the premium is changing.
The following are the procedures to use when a change in eligibility is reported or discovered.
An Adverse Action (IM-80) must be sent to notify the participant of the requirement to pay a premium. The Adverse Action informs the participant that the current non-premium level of care will end and a premium payment is required to continue to receive MO HealthNet coverage.
Once the Adverse Action (IM-80) expires, the Action Notice (IM-33) is sent. The Action Notice states coverage continues for 60 days, and a premium payment is required to receive coverage past the 60th day. If the premium is not received by the end of the 60-day period, coverage in the non-premium LOC ends and eligibility for premium coverage is closed.
When a change is entered into MEDES which results in a change from premium to non premium, MEDES will change the individual to the appropriate level of care. The eligibility date for the non-premium level of care starts the first of the month of non-premium eligibility. MO HealthNet Division determines premium refunds.
Any time there is a change in the level of care, an Action Notice (IM-33) it sent to notify the family of the effect of the change. An Adverse Action (IM-80) is not required when the LOC changes from a non-premium level of care to another non-premium level (example: family’s income increases, changing child from MC+133 to CHIP0).
This requirement is the same as for MAF. Refer to Section 1805.025.20.
Families with income above 150% of poverty must pay a monthly premium for their children to be eligible for coverage. The MO HealthNet Division's (MHD's) Stakeholder Services Unit (formerly the Premium Collections Unit) notifies the participant of the monthly premium amount and provides direction on how to make the payment. If payment is not received within 15 days, a second and final notice is sent by MHD requesting payment. If the initial premium is not paid, after 90 days MHD will notify the Family Support Division (FSD) to close the case.
NOTE: Children who are members of a federally-recognized American Indian or Native Alaskan tribe may not have to pay a premium for CHIP level health care coverage. To stop owing a premium, qualifying households should contact the MHD Stakeholder Services Unit at 800-392-2161 for more information.
Premiums may change on July 1 of each year. Refer to the MO HealthNet for Kids - CHIP Premium Chart at Appendix E, Section 1800.000.00.
Premiums are calculated as follows:
Approval in the CHIP Premium group does not mean a child will receive coverage. It means the family is eligible to buy medical coverage for their child(ren) through the MO HealthNet for Kids CHIP Program. Premium payments are required for the below groups. Eligibility and coverage begin as follows:
There is no waiting period to begin eligibility. Once the child(ren) is determined eligible for CHIP73 or CHIP74, an invoice is mailed. Coverage begins the date the premium is received, not the eligibility start date.
RSMo Section 208.646 and State Regulation 13 CSR 70-4.080 require a 30-day waiting period from the date of application for coverage to begin for children whose family's gross income is over 225% of the FPL (CHIP 75). The eligibility start date is 30 days from the date of application. If the premium is paid within 30 days from the date of application, coverage is effective on the 30th day after application. The day following the day of application is considered day one. If the premium is not paid within the 30-day period, coverage is effective the date of receipt of the premium. RSMo Section 208.647 makes an exception to the 30-day waiting period for children determined to have special healthcare needs (Section 1820.020.05.20). For children determined to have special healthcare needs, the eligibility start date is the date of application and coverage starts on the date the premium is paid.
The Managed Care Enrollment Inquiry (MCII) screen displays coverage dates for individuals in the Premium groups. The enrollment date in a health plan on MCII is the first date of any coverage in the Premium group. The MCII screen is also used to show enrollment in a specific health plan in Managed Care counties. Premium group children in fee-for-service counties are assigned to a pseudo plan number. Premium group children in managed care regions are assigned to the pseudo plan until the effective date of their enrollment in a managed care health plan.
EXAMPLE: Mrs. Jones applies October 1 for her child. She meets all eligibility requirements for Premium Group coverage, CHIP73 or CHIP74. The eligibility specialist approves her case October 10. Eligibility for MO HealthNet for Kids begins October 1.
An invoice is mailed to Mrs. Jones October 11. Mrs. Jones' payment is received by the MHD Stakeholder Services Unit on October 16. Her child's coverage begins October 16.
The MO HealthNet Division Title XIX Cross Reference Eligibility (MXIX) screen in Legacy for her child displays October 1 as the Start Date. This is the Start Date for eligibility only. Check the child's MCII screen to find the date of coverage. The Enrollment Start Date for the Pseudo Health Plan is the first date of coverage; for Mrs. Jones' child, the Start Date displays October 16.
EXAMPLE: Mr. Smith applies October 1 for his two children, Jane and Jack. He meets all eligibility requirements for Premium Group coverage, Level of Care 3 (CHIP75). Mr. Smith also provides verification that Jack has special healthcare needs. In MEDES, enter Jack's special healthcare needs status in the application flow when the question is asked. Eligibility specialist approves the case October 15. Jack's eligibility for CHIP75 eligibility begins October 1; eligibility for Jane begins October 31.
An invoice is mailed to Mr. Smith on October 15, the date of approval. Mr. Smith's payment is received by the MHD Stakeholder Services Unit on October 20. Jack's coverage begins October 20, Jane's on October 31.
The MXIX screen for Jack displays October 1 as the eligibility Start Date; for Jane, the screens display the eligibility start date of October 31. The MCII screen for Jack displays October 20 as the coverage Start Date; for Jane, MCII displays October 31 as the coverage Start Date.
Failure to pay the premium at initial approval or a level of care change from non-premium to premium will not impose a penalty. MHD notifies FSD through the Information Technology Services Division (ITSD) when a case is ineligible due to non-payment of a premium and the case or child(ren) must be closed. A household that is closed for failure to pay initial premium may reapply immediately with no waiting period.
Active participants in a Reduced Premium Group (CHIP73 or CHIP74) who fail to pay a premium are not subject to any penalty period, however, coverage stops until the premium payment is received. The MO HealthNet for Kid’s case remains open unless the case is closed for other reasons (examples: failure to cooperate, no longer age-eligible child in home).
Child(ren) active in a Full Premium Group (CHIP75) whose coverage is closed for non-payment of premium any time after the coverage begins are subject to a ninety (90) day penalty for non-payment of the premium. The MO HealthNet for Kid’s case closes and coverage for the child(ren) stops.
NOTE: Whenever a Full Premium Group household reapplies for MO HealthNet for Kids within the ninety (90) day penalty period, enter the application in MEDES and review the MCII screen to determine when the case was previously closed for failure to pay the premium. Review the eligibility check in MEDES to confirm the determination. If the household is eligible for any another MO HealthNet program, the penalty will not apply. If the household is eligible for CHIP 75 deny the application.
MO HealthNet Division's (MHD) Stakeholder Services Unit (formerly the Premium Collections Unit) is responsible for collecting the monthly premiums. MHD uses a series of notification letters and invoices for collecting the premium. The order the notifications are sent to participants is as follows:
Upon approval, a premium notice, initial invoice, is sent to the parent(s) or guardian(s) notifying them the premium payment is due upon receipt of the notice and must be received before coverage begins. Recurring Invoices are sent to CHIP participants monthly. These notices inform the participant of the amount of their monthly premium and the due date.
The Failure to Pay Notice is sent to participants whose premium payment is not received by the due date noted on the Recurring Invoice. The Failure to Pay Notice states that premium payment is past due and gives the participant an additional 20 days for the payment to be received before coverage is ended.
The Failure to Pay Notice allows participants an opportunity to show that their income or household size has changed prior to ending coverage due to failure to pay a premium. Participants are informed that they must contact the Family Support Division (FSD) Information Center within ten days of the date of the notice to report changes in income and/or household size. If a participant reports one or both of these changes, the FSD must take the following steps:
EXAMPLE: Mr. Thompson's child, Mike, has been receiving SCHIP premium coverage, CHIP74. He fails to pay the Recurring Invoice sent April 1. Mr. Thompson is mailed a Failure to Pay Notice on April 15 stating he is being given an additional twenty (20) days to pay his premium, due now by May 5. Mr. Thompson notifies the FSD on April 18 that Mike's earned income decreased by $50. The eligibility specialist (ES) verifies the change in income through requested verification and enters the adjusted income with a budget month of April. The eligibility specialist informs the participant to contact the MO HealthNet Stakeholder Services Unit for information regarding the outstanding invoice.
The Notice of Case Action is sent to participants whose premium payment is not received by the due date noted on the Failure to Pay Notices. This notice states that the participant’s premium payment has not been received, and that coverage will end in ten (10) days. Participants are informed that coverage may continue if a hearing is requested within ten (10) days.
If a participant requests a hearing due to a CHIP Premium child losing eligibility, the eligibility specialist must determine whether the reason for the hearing request is due to a case action taken by FSD or due to non-payment of a premium. If the request appears to be due to non-payment of a premium, the FSD eligibility specialist accepts the client's request for a hearing and completes an IM-87 Hearing Request form. The IM-87 must be faxed to the MO HealthNet Hearings Unit at (573) 526-2471 on the date of the request. Scan the original IM-87 to the participant's case record in the Virtual File Room. FSD staff must not tell the participant that they must contact the MO HealthNet Division's (MHD's) Stakeholder Services Unit (formerly the Premium Collections Unit) to request the hearing.
MHD's Stakeholder Services Unit will continue to provide coverage for the child(ren) affected by the hearing request. There will be no affect to FSD eligibility. MHD will essentially be holding the close action for failure to pay a premium. If the participant loses the hearing, MHD will send the closing action to close coverage and/or eligibility. MHD will file the claim for any MO HealthNet coverage received that the participant's child(ren) was not eligible to receive.
NOTE: Do not put a hold on the CHIP case due to a hearing requested because of non-payment of premium.
The Closing Letter is sent to participants who either:
The Closing Letter for families with income over 150% of federal poverty level (FPL) up to 225% FPL (CHIP 73 and CHIP 74) states coverage may start again when the premium payment is received, and contains an Initial Invoice. The Closing Letter for families with income over 225% FPL but less than 300% FPL (CHIP 75 cases) states coverage ends and the child(ren) will not be eligible for coverage for 90-day.
Both Closing Letters give the participant the right to appeal the decision for ninety (90) days.
MHD will automatically stop coverage upon notification that the premium was not paid by the due date (date of Closing Letter). The ending eligibility date on the MXIX screen will not reflect the actual date coverage ended. Check the MCII screen for the correct beginning and ending date of coverage for the Premium Group (CHIP73/74). The enrollment stop date is the last day of coverage.
If contacted by a participant who states they did pay the premium, FSD staff should refer the participant to the MHD Stakeholder Services Unit (formerly the Premium Collections Unit) at 1-800-392-2161.