Subpart
1.
Premium payments.
Applicants and enrollees must pay a premium to enroll and to
continue enrollment in MinnesotaCare. The amount of premium is the total of the
following:
A. $4 per month for each
child in a family whose family income is at or below 150 percent of federal
poverty guidelines; and
B. for any
family member not included under item A, a premium calculated under Minnesota
Statutes, section
256L.15.
A premium payment table and an explanation of the table is
available upon request from the department.
Subp. 2.
Gross annual family
income.
"Gross annual family income" means the total income of all
family members determined according to items A to C:
A. the income of self-employed persons, as
defined in Minnesota Statutes, section
256L.01, subdivision
4;
B. the income of wage earners,
including all wages, salaries, commissions, and other benefits received as
monetary compensation from employers before any deduction, disregard, or
exclusion, calculated by determining:
(1)
income in the four calendar months immediately preceding the month of
application for MinnesotaCare, multiplied by three to reflect a 12-month
period; or
(2) if the wage earner
is employed on a seasonal basis or receives income too infrequently or
irregularly to be calculated under subitem (1), total income for the past 12
months; and
C. the
following unearned income received in the four calendar months immediately
preceding the month of application, multiplied by three to reflect a 12-month
period:
(1) Supplemental Security Income
under title XVI of the Social Security Act;
(2) Social Security benefits;
(3) veterans' administration
benefits;
(4) railroad retirement
benefits;
(5) unemployment
benefits;
(6) workers' compensation
benefits;
(7) child
support;
(8) spousal maintenance or
support payments; and
(9) income
from any other source, including interest, dividends, and rent.
Applicants and enrollees must report to the department any
changes from the amounts reported in items A to C that exceed $50 per month.
Changes may be reported as a percentage increase or decrease. Gross annual
family income will be recalculated by projecting the adjusted income for 12
months.
Subp.
3.
Premiums paid monthly, quarterly, or annually.
Applicants and enrollees may choose to pay premiums on a
monthly, quarterly, or annual basis and may change payment schedules at the
time a premium is due.
Subp.
4.
Billing notices.
The department shall mail premium payment billing notices as
follows:
A. for monthly premiums, by
the first day of the month preceding the month for which coverage will be
provided;
B. for quarterly
premiums, by the first day of the month preceding the first month of the
quarter for which coverage will be provided; and
C. for annual premiums, by the first day of
the month preceding the first month of the year for which coverage will be
provided.
Subp. 5.
Premium payment dates.
Premium payments are due as follows:
A. An initial premium must be received by the
department within four months after the date on the applicant's first premium
notice.
B. Subsequent premiums must
be received by the department as follows:
(1)
monthly premiums by the 15th of the month preceding the month for which the
premium is paid;
(2) quarterly
premiums by the 15th of the month preceding the first month of the quarter for
which the premium is paid; and
(3)
annual premiums by the 15th of the month preceding the first month of the year
for which the premium is paid.
Subp. 6.
Disenrollment.
The commissioner shall disenroll enrollees who fail to pay the
required premium when due. MinnesotaCare coverage terminates the last day of
the calendar month following the due date specified in subpart
5 unless the premium is
received by noon of the last business day of the calendar month following the
due date.
Subp. 7.
Reenrollment.
An enrollee disenrolled for failure to pay the required premium
may reenroll as provided in items A to D.
A. The enrollee:
(1) may not reenroll until four calendar
months after the date coverage terminates, unless the person demonstrates good
cause for nonpayment; and
(2) must
comply with parts
9506.0010 to
9506.0100 and pay the unpaid
premium for any month in which coverage was provided.
B. Good cause for nonpayment does not exist
if a person chooses to pay other family expenses instead of the MinnesotaCare
premium.
C. Good cause for
nonpayment means, generally, circumstances beyond an enrollee's control or that
were not reasonably foreseeable that excuse an enrollee's failure to pay the
required premium when due, including circumstances such as:
(1) because of serious physical or mental
incapacity or illness, the enrollee fails to pay the premium;
(2) the enrollee voluntarily disenrolls under
the mistaken belief that other health coverage is available; or
(3) the enrollee does not receive a regular
source of income on which the enrollee has relied to pay the required
premium.
D. The
commissioner shall determine whether good cause exists based on the weight of
the supporting evidence submitted by the person to demonstrate good
cause.
Subp. 8.
Premium payment adjustments.
The commissioner shall adjust enrollees' premium payments upon
receipt of the audit information required under part
9506.0060, subparts
1 and
2. Adjustments to premium
payments are effective on the first day of the month following issuance of an
adjusted premium invoice.
