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In the event of any default taking place in the election or appointment of representatives of insured persons, the Commissioners may anytime thereafter order that the default be made good by election or appointment in such manner because they may direct. In giving directions for making good any default, the Commissioners will observe as nearly as seems expedient the lines of procedure laid down for ordinary appointments. If the default isn’t made good by a date in the month of June specified in the regulations, the appointment of representatives to supply the default is to be forthwith created by the Commissioners such manner because they may think proper.

Representatives of insured persons on Insurance Committees hold office for three years. Retiring members meet the criteria for re-appointment or re-election. – A member appointed to fill a casual vacancy holds office limited to the unexpired part of the three years’ period.

The choice of representatives of insured persons isn’t limited to persons possessing any particular qualification, and persons are accordingly eligible who are not themselves insured beneath the Act or who are not members of the Society appointing them. Where, however, a representative of insured persons who, at the date of becoming such, was an associate or the official of the ” A ” Society appointing him or of 1 of the ” B ” Societies taking part in his election, ceases to be always a member or official, because the case may be, of such Society, his tenure of office as a member of the Committee is, if the Society so decides, terminable ten days thereafter, or at such later time as may be fixed by the Society. The Secretary of the Society is to intimate any decision to the effect to the Clerk by registered post.

The Clerk must thereupon send notice of the Society’s intimation to the member in question, and must notify the Commissioners a vacancy will arise ten days after the date of his receipt of the Society’s intimation, or at any later 10 date that the Society could have specified. Forms for giving the intimation and notices are prescribed. The member in question may appeal to the Commissioners against the termination of his tenure of office, and the decision of the Commissioners on his appeal is final.

If the member was elected to represent several ” B ” Societies and has transferred in one Society to some other in the group, the Commissioners must take this fact under consideration in dealing with the appeal. Pending your choice of the appeal, the member is to continue steadily to hold office if the Commissioners so determine

Six consecutive months’ absence from meetings without leave of the Committee involves unconditional disqualification of a representative of insured persons unless the reason for absence is the member’s employment in the naval or military forces during the present war. The half a year are counted from the date of the first meeting that your representative failed to attend, and at the end of the time he ceases to be always a person in the Committee.

” Meeting ” would be to include Kaiser Foundation Calculator meetings of any Sub-Committee of the Insurance Committee in addition to meetings of this Committee or any of its Sub-Committees in conference with persons not members of the Committee.


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Policy Reference Case Maintenance Activities

• Notify Third Party Liability (TPL) Unit when CommonHealth Basic or Plus is approved. – Send copies of both sides of the enrollment form to TPL.

• Issue temporary CommonHealth card if requested for medical needs during period before client receives MassHealth card for CommonHealth Basic.

• Client receives MassHealth card.

• If ineligible because of income, PACES sends CommonHealth denial letter. – If ineligible individual is disabled, determine eligibility for CommonHealth as a disabled adult.

• Complete SMARTS Transmittal sheet for key entry. CommonHealth Policy Manual Welfare to Work Citation 513.000 – 513.600 Issue temporary CommonHealth Basic card when necessary for clients who are not currently enroDed in HMO’s. Review family income, availability of employer or other third-party insurance.

– One year after enrollment; – When changes are reported; or – When waiting period ends for employer health insurance. Review availability of and participation in employer’s health insurance plan Kaiser Calculator every six months for CommonHealth Assist cases.

– Complete PACES Worksheet to:

• adjust Department’s contribution toward employer-offered premium (if appropriate); and send notice advising client of new amount.

• If employer-offered health insurance becomes available to a CommonHealth Basic or Plus enrollee:

– Complete PACES Worksheet and TD. PACES will:

• determine eligibility for CommonHealth Assist:

• determine amount of Department’s contribution: and

• send approval letter informing client of amount of Department’s contribution. If client wishes to disenroll from HMO and chooses CommonHealth Basic, notify HMO representative to complete disenrollment paperwork.

Complete PACES TD and/or Worksheet to close case. PACES sends closing letter giving either advance notice or adequate notice depending upon the closing reason (see PACES User’s Guide)

. If client reports a change in income: – Verify income of all family members. – Complete PACES Worksheet. PACES will:

• determine if income is below 185% of federal poverty level; and

• adjust Department’s contribution to employeroffered health insurance. If client reports a change in household composition:

– Add or remove family member on PACES TD.

– PACES sends appropriate notification letter. If client moves:

– Complete PACES TD to change address and. if necessary, transfer case.

– Review HMO’s accessibility to client.

– PACES sends notice to client when case transfers.

– Tell client to contact worker in new office.

Replacing a Check Send referral to HMO marketing representative when: – Client moves;

– Case closes; or

– Household composition changes.

If client reports CommonHealth Assist check is lost, stolen, or not received;

• Confirm that the check was mailed and issued to correct address.

• See if the check has been returned to office and remail.

• Complete FCB-1 with your client.

• Give the FCB-1 to Data Entry Operator:

– immediately when your client received the check and it was lost or stolen then; or

– after waiting 2 days beyond check date

– when the check was delayed in the mail and your client confirms non-receipt.

• Meet with your client if FCB-2 is received from Finance to review signature on cashed check.

• Help your client complete FCB-3 when requested by Finance because the original check was cashed and signature on check is not your client’s signature:

• Check the Local Office Recipient Replacement Check Register and send NFL-9 to your client when replacement check has been issued.

Policy Reference Reminders AFDC policy Manual Stolen and Lost Checks Citation 306.500 – 306.520

• CommonHealth Basic clients shall receive a MassHealth card.

– TPL closes case on CommonHealth Basic and opens on CommonHealth Plus when client is enrolled in HMO.

– Client receives HMO card (MassHealth card will no longer be valid).

• CommonHealth Assist clients will not receive a card. They will receive a monthly check as a contribution toward the cost of their employer-offered health insurance.

Kaiser Calculator Health Insurance

Medigap policies pay most, if not all, of the Original Medicare Plan outpatient and coinsurance copayment amounts. These policies may also cover the Original Medicare Plan deductibles. Some of the policies cover extra benefits to help pay for more of those things that Medicare doesn’t cover, like prescription drugs. If you live in Massachusetts, Minnesota, or Wisconsin.

What Medigap Policies Don’t Cover

• Long-term care

• Vision or dental care

• Hearing aids

private-duty nursing •

• Unlimited prescription drugs Who Can Buy A Medigap Policy?

To buy a Medigap policy, you generally must have Medicare Part A and Part B. If you are under age 65 and you are disabled or have End-Stage Renal Disease (ESRD), you might not be able to buy a Medigap policy until you turn 65.

Medigap Plans A through Basic (Core) Benefits All Medigap plans must cover these basic (core) benefits

• The Medicare Part A coinsurance amount.

• The cost of 365 extra days of hospital care during your lifetime after Medicare coverage ends.

• The Medicare Part B coinsurance or copayment amount.

• The first 3 pints of blood each year. How Much Do Medigap Policies Cost? This Guide can’t include actual costs for Medigap policies. As you shop for a Medigap policy, you will need to call insurance companies that sell Medigap policies in your state and ask about prices. The cost for Medigap policies will be different depending on:

• Your age,

• Where you live, and

• The insurance company.

There can be big differences in the premiums that insurance companies charge for exactly the same coverage. When you compare premiums, be sure you are comparing the same Medigap policies. Insurance companies have 3 different ways of pricing policies based on your age. In general, no-age-rated (also called community-rated) policies are the least expensive Kaiser Calculator over your lifetime.

Other Factors That May Affect Your Cost:

• Whether you are female or male. Some companies offer discounts for females.

• Whether you smoke or not. Some companies offer discounts for non-smokers.

• Whether you are married or not. Some companies offer discounts for married couples.

• Medical Underwriting. This is a process that a ongoing company

uses to review your health and medical history, and decide whether to accept your application for insurance. With medical underwriting, you must answer medical questions on an application usually. You need to carefully fill out this application. Some companies may want to review your medical record before they sell you a policy. The company may use this information to add a waiting period 15 How Much Do Medigap Policies Cost? (continued) Other Factors That May Affect Your Cost:

• Medical Underwriting, (continued) for pre-existing conditions if your state law allows. The company may also use this information to decide how much to charge you for a Medigap policy. Insurance companies may “medically underwrite” any Medigap policy at times other than your Medigap open enrollment period or when you have the right to buy a Medigap policy

• Whether a High is bought by you Deductible Option Policy. Insurance companies may offer a “high deductible option” on Medigap Plans. If you choose this option, you must pay a $ 1 ,620 deductible for the full year 2002 before the plan pays anything. This amount can go up each full year. High deductible option policies cost less, but if you get sick, your out-of-pocket costs shall be higher and you may not be able to change plans. In addition to the $1,620 (in 2002) deductible that you must pay for the high deductible option on Plans.