Report an Additional TPL Resource

Report a new TPL resource when HFS 1442/1442CF was submitted for another resource. On the new HFS 1442/1442CF:

  • state "Additional Insurance" in the Remarks Section,
  • check the "update" box, and
  • enter the caseworker's name, caseload number, date, and FRC's signature.

The TPL Section changes the TPL resource code in Item 79 of HFS 552, if needed, to reflect the entire coverage. 

Report TPL Coverage for an Additional Person

Report a person who becomes eligible for the same coverage as others in the unit or a person who is being added to the unit who has the same TPL resource already reported for other members. Copy the case record copy of the prior HFS 1442/1442CF and:

  • in Item 7 enter the client's name, RIN, date of birth, beginning date of insurance coverage, and ending date, if appropriate;
  • write "Person(s) Added" in the Remarks Section;
  • check the "update" box;
  • enter the caseworker's name, caseload number, date, and FRC's signature; and
  • enter the 3-digit TPL resource code in Item 79 of HFS 552.

NOTE: If the original HFS 1442/1442CF for this TPL resource is not available, complete another form. Clearly indicate the new information. 

Report the Termination of a TPL Resource for a Member(s) of the Unit (To Delete the TPL Code)

Report insurance coverage that was previously reported that has ended or lapsed for one or all unit members. Copy the case record copy of HFS 1442/1442CF and:

  • in Item 7, enter the date the insurance coverage ended for the appropriate unit members. This is important to avoid the rejection of claims from medical providers when the TPL resource is no longer available;
  • state "Insurance Ended" in the Remarks Section;
  • check the "update" box; and
  • enter the caseworker's name, caseload number, date, and FRC's signature.

NOTE: If the original HFS 1442/1442CF for this TPL resource is not available, complete another form. Clearly indicate the new information.