PM 06-08-01-a

HFS's 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/FamilyCare 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 the family verifies current income and it 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. However, an adult on the case may become ineligible.

All children in the same family must be on the same All Kids Premium case, so that the premium for the family is charged correctly. Adults in Premium Level 1 must also be on the same Premium case as their children.

Example: Mrs. F applies for All Kids for her 3 children who receive child support. In the initial calculation for All Kids Assist based on total family income, the children are ineligible.

The worker completes a manual calculation for each child to determine Assist eligibility. The children are still ineligible for All Kids Assist due to income. The children are then determined eligible for All Kids Premium with all 3 children on one case.

If the children were approved in separate All Kids Premium cases, the family would be charged a monthly premium of $45 ($15 X 3) instead of the correct $30.

The family receives one billing statement for a charge of $30. If the children were approved in separate All Kids Premium cases, the family would incorrectly receive separate billing statements of $15 each for a total charge  of $45 ($15 X 3) instead of the correct $30.

Family Care Premium Levels 2 and 3

Adults in Premium Levels 2 and 3 are on separate cases from their children.  The All Kids Unit calculates the monthly premiums for these cases and sends this information to the HFS Bureau of Fiscal Operations (BFO) for billing. The parents receive an initial invoice and a monthly billing statement. If the children are also receiving All Kids Premium, BFO sends them a combined monthly billing statement.

Form 552 Coding for Premium Levels

revised textForm 552 code 192 in item 80 displays the monthly premium amount and case level for All Kids/FamilyCare Premium Level 1 and All Kids Premium Level 2.  Following approval, each renewal, and each decrease in income, the premium level is centrally calculated using the countable monthly income code 177 in Item 80.  When the premium amount is changed, a billing statement is sent to the family to notify them of the new premium amount. 

The example below shows a 192 code for an All Kids case containing 2 or more children approved for All Kids Premium Level 2.

Code

Item

Abbrev.

Amount Persons Total Cost

Sup.

By

192

(Centrally entered only)

PREM 80.00 2