1810 WHIPP (Third Party Liability)
| Medical Assistance - 42 CFR 435.610 |
A. Purpose:
1. The Wyoming Health Insurance Premium Payment program (WHIPP) operates through WDH;
2. The WDH will evaluate cases referred from the DFS-CO’s to determine if the client’s premium for health insurance is cost effective and pay the premium if it is found to be cost effective;
3. Each Adult client must participate in her/his Health insurance plan if WDH determines the plan is cost effective.
B. Eligibility requirements:
1. Require, as a condition of eligibility, each adult to Cooperate with the WHIPP program by:
a. Maintaining existing health insurance;
b. Disclosing all information of any Available health insurance at the time of Application or Reapplication.
2. Sanction legally responsible adult assistance unit members who do not cooperate with the WHIPP program.
C. Services/Benefits:
1. WHIPP may cover services not covered under a coverage group;
2. Premium payments for a non-medical eligible Assistance unit member may be covered under WHIPP when WDH has decided buying a family plan for the eligible member(s) is cost effective;
3. WHIPP covers premiums, co-insurance, deductibles and other cost sharing obligations for eligible individuals.
D. Benefit processing:
1. Forward WHIPP forms to the WDH only when an assistance unit member has a medical Need based on information received:
a. Refer to the form instructions to determine when a referral is required;
b. File a copy of the WHIPP form in the case record.
2. Enter TPL information on the MEIN screen;
3. Inform the client the effective date of premium payment when WHIPP services are approved shall begin:
a. With the Month of application or the month of eligibility, whichever is later, when a client is enrolled in a health plan;
b. With the month of enrollment or the month in which the plan is determined cost-effective, whichever is later, when a Recipient enrolls in a health plan after becoming eligible;
c. With the month in which the WHIPP form is filed when premium payments for WHIPP are not group health insurance;
d. In the month in which the first premium payment is due if the person is not currently enrolled in the plan.
4. Understand WDH will not make payments if the premium was used as a deduction when determining client participation or for premiums due prior to application;
5. Understand the WDH will make payment directly to:
a. The policyholder upon Verification the policyholder pays the premium through payroll deduction or personal check; or
b. The Administrator of group insurance programs when there is not verification of policyholder payment.
6. Realize claims from medical care Providers for persons participating in WHIPP will be paid in the same manner as other claims with third-party Resources (WDH is the last payer);
7. Know premiums shall not be paid for health insurance plans if:
a. The insurance plan belongs to the non-custodial parent;
b. The insurance plan is designed to provide temporary coverage, (e.g. 30 to 180 days);
c. The persons covered under the plan are not eligible on the date the eligibility decision for WHIPP is made; or
d. The WHIPP program has determined the purchase of the insurance is not cost effective.
8. Realize premium payments under WHIPP will be discontinued when the assistance unit loses eligibility.
E. Reviews will occur whenever:
1. A premium rate or coinsurance increases;
2. Some of the persons covered lose eligibility;
3. Services covered under the policy decrease; or
4. There is a decrease in the amount paid by the insurance company over several months.
F. Inform the client re-enrollment to private health insurance will not be necessary after termination of eligibility to enable individuals to continue with the same insurance plan or physicians after termination from Employment.
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