PM 06-08-05

revised textThe family must sign a Request for Medical Benefits for Another Family Member(s) (Form 243C) to have a family member added to an All Kids/FamilyCare Share, Premium or Rebate case. This also applies to newborns.

revised text(System) When the person is added to the case by the FCRC or the All Kids Unit, Notice of Decision for Addition of a Family Member (Form 3718) is centrally generated notifying the family of the approval.

(FCRC/All Kids Unit) If the person is not eligible to be added to the case, send a manual Form 3718.

Example 1: The R family receives Share. On 12/13/07, the worker receives Form 243C requesting to add Ms. R's newborn to the Share case. Add the newborn to the Share case effective 01/08. Do not review income unless Ms. R asks to be considered for Assist or Moms & Babies. If Ms. R wants her child to be considered for Assist or Moms & Babies, she must provide current verification of income.

The family can request prior coverage to cover the newborn from 11/29/02 (2 weeks prior to the date the request was signed).

Example 2: The P family receives Share for their son. On 10/06/07, Mr. P brings in Form 243C to add his daughter to the Share case. Mr. P asks that eligibility for Assist be determined because of the change in family size.

Current verification of income indicates that the family is eligible for Assist beginning 09/07. Cancel the Share case and set up an Assist case for both children effective 09/07.

Example 3: The Q family receives Share for their son. On 11/12/07, the All Kids Unit receives Form 243C to add their daughter to the case and asks that eligibility be reviewed due to the change in family size.

Current verification of income indicates that family income falls in the Premium Level 1 range. Leave the case as a Share case until the next renewal.

Example 4: The S family receives Premium Level 1 for their daughter. On 11/04/07, the FCRC receives Form 243C to add Ms. S's son to the Premium case. Add the son to the Premium case effective 12/07. The premium increases from $15 to $20 effective 12/07.

new textRefer to PM 06-08-03-e for information about prior coverage when adding a child to an All Kids Share or Premium case.

new textRefer to WAG 06-08-03-f for procedures regarding FamilyCare Share or Premium backdating when adding an adult to a case.