Premium Assistance. Under the SBE Premium Assistance Program, the Commonwealth will make premium assistance payments for certain individuals whose gross family income is greater than 133 percent of the FPL and less than or equal to 300 percent of the FPL, who work for employers with 50 or fewer employees, who have access to qualifying ESI, and where the member is ineligible for other subsidized coverage through MassHealth or the Health Connector. Benefits are limited to premium assistance payments for qualifying ESI that meets basic benefit level (BBL) standards.
Premium Assistance. For most individuals eligible for MassHealth, the Commonwealth may require as a condition of receiving benefits, enrollment in available insurance coverage. In that case, Massachusetts provides a contribution through reimbursement, direct payment to the insurer, or direct payment to an institution of higher education (or its designee) that offers a Student Health Insurance Plan (SHIP), toward an individual’s share of the premium for an employer sponsored health insurance plan or SHIP which meets a basic benefit level (BBL). The Commonwealth has identified the features of a qualified health insurance product, including covered benefits, deductibles and co-payments, which constitute the BBL. Each private health insurance plan is measured against the BBL, and a determination is then made regarding the cost-effectiveness of providing premium assistance. For individuals eligible for premium assistance only through the SBE ESI program, this same test will apply. If available and cost effective, the Commonwealth will provide premium assistance on behalf of individuals eligible for Standard (including ABP 1), CarePlus or CommonHealth coverage, to assist them in the purchase of private health insurance coverage. The state will also provide coverage for additional services required to ensure that such individuals are receiving no less than the benefits they would receive through direct coverage under the state plan. This coverage will be furnished, at the state option, on either a FFS basis or through managed care arrangements. These individuals are not required to contribute more towards the cost of their private health insurance than they would otherwise pay for MassHealth Standard (including ABP 1), CarePlus or CommonHealth coverage. Cooperation with the Commonwealth to obtain or maintain available health insurance will be treated as a condition of eligibility for all of those in the family group, except those who are under the age of 21, or pregnant.
Premium Assistance. Expenditures for premium assistance payments to enable individuals enrolled in CommonHealth (Adults and Children) and Family Assistance to enroll in private health insurance to the extent the Commonwealth determines that insurance to be cost effective. Pediatric Asthma Pilot Program. Expenditures related to a pilot program, as outlined in STC section VI, focused on pediatric asthma. The authority for this pilot program to receive FFP is subject to CMS approval of the protocols and amendments to such protocols as outlined in section V. Diversionary Behavioral Health Services. Expenditures for benefits specified in Table C of Section V to the extent not available under the Medicaid state plan. Expanded Substance Use Disorder Services. Expenditures for benefits specified in Table D of Section V to the extent not available under the Medicaid State Plan.
Premium Assistance. For most individuals eligible for MassHealth, the Commonwealth may require as a condition of receiving benefits, enrollment in available insurance coverage. In that case, Massachusetts provides a contribution through reimbursement, direct payment to the insurer, or direct payment to an institution of higher education (or its designee) that offers a Student Health Insurance Plan (SHIP), toward an individual’s share of the premium for an employer sponsored health insurance plan or SHIP which meets a basic benefit level (BBL). The Commonwealth has identified the features of a qualified health insurance product, including covered benefits, deductibles and co-payments, which constitute the BBL. Each private health insurance plan
Premium Assistance. There are three programs offering premium assistance under this Demonstration; VHAP-ESI, ESI premium assistance (non-VHAP), and Catamount premium assistance. As the Single State Agency for Medicaid, AHS will have authority and responsibility for eligibility determination related to these premium assistance programs. The role filled by AHS will be identical to that of Single State Agencies in other States. The AHS PMPM limits include these eligibility groups. The methodology for providing premium assistance for each of the three programs is described below:
a. VHAP-ESI. AHS determines eligibility, processes enrollment and makes the determination that ESI is cost effective. DVHA transfers to the beneficiary an amount of premium assistance that does not exceed the amount that the employer withholds from the employee’s wages for the employee premium share of employer-sponsored insurance. DVHA provides additional benefits to ensure that the beneficiary receives the full VHAP benefit package in the aggregate.
Premium Assistance. AHS determines eligibility and processes enrollment in Catamount Premium Assistance. The beneficiary pays a premium contribution to AHS and DVHA pays the total premium for the beneficiary to enroll in a private Catamount Health plan. There is no additional wraparound benefit.
Premium Assistance. For optional categories of children who choose to receive coverage through premium assistance, as well as for the optional parents, who are enrolled in premium assistance, CMS is approving the benefit package available through the private or employer- sponsored insurance company as the benefit package to be delivered. (See discussion in STC
Premium Assistance. In lieu of COBRA reimbursements, GPCM agrees that, for a period of 24 months commencing in the month after the Termination Date, GPCM shall pay to Bxxxxxxxx a monthly payment of $3,000 on the first of each month commencing after the Termination Date to assist Bxxxxxxxx in securing health care coverage. Nothing contained in this Section 2 shall preclude Bxxxxxxxx from electing COBRA coverage under GPCM’s health plan in accordance with applicable law at his sole election or from using a portion of the payments he receives under this Section 2 to fund such coverage, provided that he does not seek any further reimbursement therefor from GPCM.
Premium Assistance. Under the RHIPA Plan, early retirees who participate in the Self-Funded Plan may receive premium assistance.
(a) Effective January 1, 2019 eligible retirees receive Pre-65 and Post-65 premium assistance benefits as follows: Eligible Retirees who leave the Self-Funded Plan when they become Medicare eligible, including retirees who become Medicare eligible prior to age 65 due to disability, may be eligible to receive fifty percent (50%) of the value of the monthly premium assistance through monthly contributions to their retirement health savings accounts. This value will be accomplished through a monthly contribution to the retiree’s Retirement Health Savings account from the sub-account assets. Years of Service Pre-65* Benefits: Monthly Premium Reduction Post-65 Benefits: Years of Post-65 Benefits at 50% 25 $500 17 20 $400 11 15 $300 6 10 $200 0 ** *Retirees eligible for Medicare due to disability prior to age 65 will receive the Post-65 benefits. **Refer to Section 3(c) in this Article for grandfathering provision.
(b) Employees who are hired on or after January 1, 2019 receive Pre-65 premium assistance benefits. Years of Service Pre-65 Benefits: Monthly Premium Reduction 25 $500 20 $400 15 $300 10 $200
(c) Current post-65 retirees with ten (10) years of service or those retirees who will become eligible for post-65 benefits by December 31, 2019 will receive $100 per month in their RHS account from their date of post-65 eligibility through December 31, 2019.
(d) The monthly retiree medical subsidy will be increased by ten percent (10%) beginning on January 1, 2029 and every five (5) years thereafter.
Premium Assistance. Section One.
