The Third Party Liability-Other Health Insurance Detail page is where information is captured for a consumer’s third party private insurance. Information entered on this page is sent through an Interface to the MMIS.
In the context of the case:
Select Eligibility from Global Navigation. Select Customer Information from Local Navigation. Open the financial data pages by clicking on the + beside Financial in Task Navigation. Select Other Health Insurance from Task Navigation. The Third Party Liability - Other Health Insurance List page displays.
Click the Add button. The Third Party Liability - Other Health Insurance Detail page displays.
Select the Beneficiary(ies) from the multi-select menu of case members.
Select the Health Coverage type from the drop-down menu.
The option of None should only be selected when the consumer does not have other health insurance, but the user wishes to complete the Access To Health Insurance questions located at the bottom of the page. It is important to note that the question Member has health insurance that has ended in the past 3 months is not currently tied to any EDBC Rules functionality. If the user is attempting to apply a Penalty.
Comprehensive Health Insurance requires ‘Doctor’ and ‘Hospital’ to be selected or EDBC will not fail when CHIP coverage is determined.
Enter the Start Date for the record.
NOTE: If the policy is ending during the application or prior medical months an End Date should be entered. If the policy is still active no End Date needs entered.
Enter the following information under Health Insurance Information:
NOTE: These fields are not required if None was selected from the Health Coverage type drop-down menu.
Health Insurance Company Name
Policy Number
Group Number
Is this Insurance accessible to the Beneficiary?
While this question is a required field for all programs, it is only applicable to CHIP. This question is used to indicate when comprehensive coverage is not considered accessible. Answering this question No tells EDBC that the comprehensive insurance should be ignored when making a CHIP determination.
NOTE: The Policy Number field is required to be entered to navigate away from the page. If you don’t have the policy number information, enter UNKNOWN. Entering "bad data" in the Policy Number field causes errors on the interface file. If the "bad data" is mapped from the SSP or Worker Portal, update it to UNKNOWN.
Choose Type of Coverage from drop-down menu.
Enter the following information in the Policy Holder Information section:
Policy Holder’s Name
Policy Holder’s SSN
Select Who is Covered from the drop-down menu of case members
NOTE: If the user multi-selects the Beneficiary the system creates the needed records on the Third Party Liability-Other Health Insurance List page. It is not necessary to go through the process and select each individual from the Who is Covered? drop-down menu.
Complete the Name field with the name of the Employer, Union, Group, Organization, or School associated with the insurance plan, if applicable
Enter the EIN (Employer Identification Number)
Enter the Local or Group Number
Select Yes or No from the Is this a Union drop-down menu
Enter Address information: street, city, state, zip
Enter the Telephone number
Under the Access to Health Insurance section, select Yes or No for the following questions:
Member has access to employer sponsored health insurance - Indicating Yes to this question will have NO impact on EDBC results.
Member has access to State Health Insurance - Indicating Yes to this question results in a failing CHIP budget when EDBC is run.
Member has health insurance that has ended in the past 3 months - Indicating Yes to this question will have NO impact on EDBC results.
Select Verified from the drop-down menu.
Click the Save and Return button on the Third Party Liability - Other Health Insurance Detail page to retain the data.