WAG 06-24-07 Premiums and Co-Pays

PM 06-24-07

new textMonthly premium amounts are shown on the following table:

Grossed Unearned Income $0-$250 $251 - $500 $501 - $750 $751 - $1,000 $1,001 -$1250
Countable Earned Income
$0-$250 -- $19 $38 $56 $ 75
$251 - $500 $ 6 $25 $44 $63 $ 81
$501 - $750 $13  $31 $50 $69 $ 88
$751 - $1,000 $19 $38 $56 $75 $ 94
$1,001 -$1250 $44 $63 $82 $100 $119

For premiums for higher income levels, go to www.hbwdillinois.com/.

An HBWD participant does not pay a premium when their total monthly earned income is at or below $250 and their gross monthly unearned income is at or below $250. For these participants there is no "enrolled" period and eligibility starts upon approval.

PREMIUMS FOR FIRST MONTH AND ONGOING COVERAGE

The first month's premium must be paid before benefits are authorized. The premium for the initial month of coverage must be paid by a certified check, money order, credit card, or debit card before coverage will be authorized. For subsequent months of coverage, premiums may also be paid by personal check.

HFS's Bureau of Fiscal Operations (BFO) handles all premium payments.

If the case is approved between the 1st and the 10th of the month, the first month's premium is due by the 20th of the current month. If the first month's premium is received by the 20th of the current month, eligibility begins the 1st of the following month.

Example 3: Mr. A is approved for HBWD on 12/03/07. His first premium is due 12/20/07. If payment is received by 12/20/07, HBWD coverage begins 01/01/08. If the case is approved between the 11th and the end of the month, the first month's premium is due by the 20th of the following month. If the first month's premium is received by the 20th of the following month, eligibility begins the first of the next month.

Example 4: Mr. B is approved for HBWD on 01/13/08. His first premium is due 02/20/08. If payment is received by 02/20/08, HBWD coverage begins 03/01/08. If the participant doesn't pay the premium by the due date, the HBWD case will cancel.

Example 5: Mr. A (from Example 3) doesn't pay his premium by 12/20/07. He also has QMB. A TA 31/TAR B4 is processed to change the case to QMB Only. The HBWD Unit transfers the QMB only case to the appropriate FCRC.

PREMIUMS FOR BACKDATED MONTHS

The participant has 90 days from the date on the approval notice to pay premiums for any additional months they were eligible for HBWD between the 3rd backdated month and the initial month of coverage.

Example 6: Ms. D is eligible for HBWD on 03/08/08. She requests backdating and was eligible back to 12/01/07. Ms. D is notified that her HBWD benefits will begin 04/01/08 if she pays one monthly premium of $25 by 03/20/08. She is also notified that she has 90 days to pay additional premiums for prior months. She has the following options for the prior months:

  • she can receive coverage for 03/08 if she pays an additional $25 (one monthly premium); or
  • she can receive coverage for 02/08 and 03/08 if she pays an additional $50 (2 monthly premiums); or
  • she can receive coverage for 01/08, 02/08, and 03/08, if she pays an additional $75 (3 monthly premiums); or
  • she can receive coverage for 12/07, 01/08, 02/08, and 03/08, if she pays an additional $100 (4 monthly premiums).

Example 7: Mr. E is approved for HBWD on 03/14/08. He requests backdating to 12/01/07, but was only eligible beginning 3/08. Mr. E is notified that his HBWD benefits will begin 05/01/08 if he pays the monthly premium of $31 by 04/20/08. He is also notified that he has 90 days to pay additional premiums for prior eligible months. He has the following options for the prior months:

  • He can receive coverage for 04/08 if he pays an additional $31 or
  • He can receive coverage for 03/08 and 04/08 if he pays an additional $62 (2 monthly premiums).