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Premium Processing

Now that you know how MA-EPD premiums are calculated, let's discuss some of the processes involved with the payment of premiums.

If an applicant requests retroactive coverage:

Have MAXIS determine if a premium is required for retro months.

Pend the results in MAXIS.

 

Once an applicant has been determined eligible for MA-EPD, before you have approved eligibility you will need to collect the initial premium(s). The initial premium can include the following:

Overdue premiums that applicant owes for previous MA-EPD coverage.

Requested retro months and the application month.

For all months plus the current month plus one if you are processing the application on or after the 15th of the month.

For all months through the processing month if you are processing after the application month.

The additional Unearned Income Obligation-UIO, for any months the applicant received unearned income.

 

Do not approve eligibility until the initial premium(s) have been paid. Once you have determined the months to include in the initial MA-EPD premium, you will need to send the form below to the applicant.

The MA-EPD Initial Premium Notice (DHS-3547).

If an enrollee contacts you regarding premium payment options, you can reference or refer them to the DHS Member Services webpage for answers to common questions and available payment options. To visit the DHS Member Services webpage, click on the EXTRA icon below.

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