PM 06-08-01-a

The HFS Bureau of Fiscal Operations bills and collects all premiums. At initial approval and for an enrolled case, a premium plan invoice is mailed. The invoice due date is 30 days from the date of the invoice.

For ongoing billing, premium billing statements are mailed by the 5th of the month prior to the month of coverage. The premium due date is the last day of the month preceding the month of coverage.

Example: The month of coverage is July. The statement is mailed on June 5th, and the due date is June 30th.

The All Kids premium amount does not change when income decreases during the 12-month eligibility period, unless the family verifies that income is at or below the income standard for the current Premium level.  If the family size increases, the family's premium may decrease if deleted textit is below the standard for the current Premium level.

If income increases during the 12-month eligibility period the premium amount does not change for the children until the next REDE. deleted text

revised textAll children in the same family must be on the same IES case, so that the premium for the family is charged correctly. deleted text

  • revised textExample: Bob applies for medical benefits for his son John, age 7, and daughter Jane, 9 months old. The household consists of Bob, John, Jane and Bob's girlfriend Mary, who is Jane's mother. Mary is not John's mother. Both Bob and Mary have earned income, and tax filer status is unknown. Using MAGI rules to determine who to include, and whose income to count in each child's EDG, John qualifies for Premium Level 1, and Jane qualifies for Premium Level 2.
  • Determine EDG for: EDG size All Kids Premium Level Monthly Premium
    John 3 (John, his father, Bob, and sibling, Jane) Counting Bob's income only,  John' qualifies for Premium Level 1 $15
    Jane 4 (Jane, her parents, Bob and Mary, and sibling, John) Counting both Bob and Mary's income, Jane qualifies for Premium Level 2 $40
  • Results: The family's total monthly premium charge is $55. 
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