A participant whose computed gross income exceeds 100% of the Federal Poverty Level (FPL) must pay a monthly premium to participate in the TWHA program. TWHA premium amounts are based on a formula specified by State statute and are adjusted annually effective April 1. The current premium amounts are:
| Type of Case | Percent of FPL | Monthly Income | Premium Amount |
|---|---|---|---|
| Single | ≤ 100% FPL | $1,012.00 or less | non premium |
| Single | >100% FPL but < 150% FPL | $1,012.01 - $1,517.99 | $40 |
| Single | ≥ 150% FPL but < 200% FPL | $1,518.00 - $2,023.99 | $61 |
| Single | ≥ 200% FPL but < 250% FPL | $2,024.00 -$2,529.99.00 | $101 |
| Single | ≥ 250% FPL but ≤ 300% FPL | $2,530.00 - $3,035.00 | $152 |
| Type of Case | Percent FPL | Monthly Income | Premium Amount |
|---|---|---|---|
| Couple | ≤ 100% FPL | $1,372.00 or less | non premium |
| Couple | >100% FPL but < 150% FPL | $1,372.01 -$2,057.99 | $55 |
| Couple | ≥ 150% FPL but < 200% FPL | $2,058.00 -$2,743.99 | $82 |
| Couple | ≥ 200% FPL but < 250% FPL | $2,744.00 -$3,429.99 | $137 |
| Couple | ≥ 250% FPL but ≤ 300% FPL | $3,430.00 - $4,115.00 | $206 |
On new approvals, participants in the premium group must select the beginning date of coverage, which may be as early as the first month of the prior quarter (if otherwise eligible) but no later than the month following approval. When approving the case, the selected beginning date is entered as the beginning date of eligibility. Thus, the eligibility specialist must discuss with the participant the amount of the premium, how premium payments received will be applied and have the participant select the month they want coverage to begin.
NOTE: If a participant is not in the premium group, coverage should begin on the first day of the first month the participant is eligible. Refer to Sections 0810.005.00 and 0810.015.00.
Upon approval, the MO HealthNet Division (MHD) will send an Initial Invoice letter, billing the participant for the premium amount for any past coverage selected through the month following approval. Coverage will not begin until the premium payment is received. If the participant does not send in the complete amount, s/he will be credited for any full month premium amount received starting with the month after approval and going back as far as the amount of premium paid allows.
EXAMPLE: Mr. Smith applies in October and the Eligibility Specialist is ready to approve him for TWHA premium group in November. He is eligible for prior quarter as TWHA. Mr. Smith's premium is $40 per month. If he selects September as his beginning month of coverage, he will owe $160 ($40 x 4) for September, October, November, and December with his first premium payment. If he selects November, he will owe $80 ($40 x 2) for the months of November and December with his first premium payment. If Mr. Smith selects November but only sends in $40, he will be given coverage starting with December. Mr. Smith could also select to pay the premium of $40 for December only. In December, MHD will send an invoice for the premium for January's coverage. Thereafter, MHD will send a Recurring Invoice on the second working day of each month for the next month's premium. If the premium is not received prior to the beginning of the new month, the person's coverage ends on the last day of the last paid month.
MHD will not send a recurring invoice to the participant after six months of non-payment of premium. The participant's eligibility for TWHA will remain open but the individual will not receive coverage until the premium is paid. Invoice information may be accessed through MPNI. The Program Field (PG) for TWHA is TW. Refer to Section 0810.010.10 for detailed information.
EXAMPLE: Mr. Jones is approved for premium coverage on 12/15/10 with a MO HealthNet beginning date of 09/01/10. On 12/16/10 Mr. Jones is sent an Initial Invoice for September 2010 through January 2011. Mr. Jones does not send a payment in response to the initial invoice. January is counted as one month of non-payment. On 1/01/11, 2/01/11, 3/01/11, 4/01/11, and 5/01/11 Mr. Jones is sent Recurring Invoices, but sends no payment for any months. This is a total of six months of non-payment. MHD will no longer send Mr. Jones a recurring invoice. Mr. Jones's case will remain active in the system but he will not receive coverage until premium payment is received.
MHD Premium Collections Unit will collect the premiums for TWHA. TWHA participants will have the option of paying the premium by automatic withdrawal. Participants who choose this option must file a form with MHD to have their premium amount withdrawn from an existing bank account. This form is located at http://dss.mo.gov/mhd/participants/pdf/ttw-ha.pdf.
Withdrawals will be made on the 15th of each month. The effective begin date for automatic withdrawals for TWHA premiums are dependent on the day the form is received by MHD and when the financial institution puts the withdrawal in place. Therefore, participants must send a check or money order to MHD to pay for the prior, current and possibly the month after sending in the form. The participant will receive a monthly confirmation of withdrawal from MHD. If a problem with the withdrawal occurs, MHD will send a letter informing the participant that their automatic withdrawal was returned. Reasons for the return and instructions on how to resume automatic withdrawal or correct the problem are included in the letter.
The MO HealthNet Division Premium Inquiry screen (MPNI) displays information regarding coverage dates based on premium payment. The Program Field (PGM) will show TWHA or SPND to differentiate between TWHA and MHABD spend down. Refer to Section 0810.010.05.
NOTE: Premium payments must be sent to the MHD Premium Collections unit at the address noted on the invoices.