PM 06-08-03-e: Prior Coverage (All Kids Share and Premium)

WAG 06-08-03-e

Adults do not qualify for Prior Coverage.

All Kids Share and Premium Level 1

Prior coverage is available only the first time a child is approved for All Kids Share or Premium Level 1. new textAfter IES Phase 2 implementation, prior coverage can be requested in one of two ways:

  1. new textPost Phase 2, IES will determine eligibility for prior coverage when a child is certified for All Kids Share or Premium Level 1 and the applicant requested at least one month medical backdate coverage on the application for that child, or
  2. revised textif the family did not request backdate coverage at application, they may submit a prior coverage request to the HFS All Kids Unit within 6 months of the initial date of All Kids Share or Premium Level 1 coverage for the child for whom prior coverage is requested. This option is available pre-Phase 2 and will continue to be available after IES Phase 2 implementation.

new textNotices: When prior coverage is authorized at initial application or when a child is added to an IES case, details about the prior coverage approval will appear in the 360C Notice of Decision as eligibility in the 'Earlier Months' coverage table. When prior coverage is authorized as a result of a request received after a child is already certified for Share or Premium coverage, the customer will be notified via Form 243KC.

Prior coverage will not be authorized if:

  • revised texta child previously received All Kids Rebate, Share or Premium, even if they did not receive prior coverage the first time they were approved for All Kids Share or Premium.
  • mew textAdditionally, prior coverage should not be authorized for a month in which spenddown is met if the spenddown met date is before the date that prior coverage would begin.
    • NOTE: IES is not yet programmed to determine eligibility for Family Health Spenddown before authorizing prior coverage.  See WAG 06-08-03-e for procedures regarding how to authorize spenddown coverage in this situation.

Authorization of prior coverage does not change the 12-month eligibility period that was set up when the case was approved.

If there is a break in All Kids Share or Premium Level 1 coverage after a family has received prior coverage, and the family is later eligible for All Kids deleted textPremium Levels 1 or 2, the family must pay their first month's premium before receiving Premium Levels 1 or 2.

Prior coverage begins 2 weeks before the date of application and ends the day Share or Premium Level 1 coverage starts. A premium is not charged for the prior coverage period.

Example: The A family applies on July 6th for the first time. The children are determined eligible beginning September 1st. Prior coverage can be authorized for the period June 22nd through August 31st.

Premium Level 2

Prior coverage is not available to children other than newborns approved for Premium Level 2. Newborns can receive medical benefits to the month of birth under certain circumstances. Refer to PM 06-08-05 for more information.