Sinclair Jefferson

<%@LANGUAGE="JAVASCRIPT" CODEPAGE="65001"%> Sinclair Jefferson

Third Party Liability - Page 9c

Sinclair Jefferson

Use Sinclair’s case information to answer the following questions.

1. Does Sinclair have other health care coverage?

Yes, Sinclair reported on the DHS-3531 that he has Health Partners coverage through his wife’s employer. A DHS-3767, Request for Group Health Plan Information has been completed to provide information about the coverage.

2. Is Sinclair’s health care coverage cost-effective?

Yes, based on the Request for Employee’s Group Health Plan Information (DHS-3767a) form, and the Determination of Cost Effectiveness form (DHS-3767D) included in Sinclair’s case packet, Sinclair’s coverage is cost-effective for both him and Mary. We will reimburse Mary the full premium amount, which cannot be used as a health care expense.

3. Does Sinclair have any other third party liability issues?

No, Sinclair does not report have any other third party liability issues on the DHS-3531.

4. Does Sinclair have to cooperate with medical support or have a parental fee assessed?

No. Although Dion is a child in his home, Dion is not requesting coverage through one of Minnesota’s health care programs.

To Do: Update Sinclair’s MA-LTC Case Checklist (DHS-5590) in the appropriate fields found on pages one and two with this information.

Updated December 24, 2020.
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