Missouri Code of State Regulations › Title 22 - MISSOURI CONSOLIDATED HEALTH CARE PLAN › Division 10 - Health Care Plan › Chapter 2 - State Membership › Section 22 CSR 10-2.110 - General Foster Parent Membership Provisions

Current through Register Vol. 49, No. 14, July 15, 2024
PURPOSE: This amendment revises default enrollment
				  procedures, clarifies disabled dependent eligibility, reporting of other health
				  coverage, and renumbers as necessary.
(1) Terms and Conditions. This rule provides
				the terms and conditions for membership in the Missouri Consolidated Health
				Care Plan (MCHCP). A foster parent and his/her dependents are required to
				provide complete, true, and accurate information to MCHCP in connection with
				enrollment, change, or cancellation processes, whether by online, written, or
				verbal communication. MCHCP may rely on, but reserves the right to audit, any
				information provided by the foster parent and seek recovery and/or pursue legal
				action to the extent the foster parent has provided incomplete, false, or
				inaccurate information.
(2)
				Eligibility Requirements.
(A) Foster Parent
				Coverage. The Department of Social Services shall provide appropriate
				documentation to MCHCP of initial and ongoing eligibility of a foster parent
				who qualifies for the purchase of MCHCP coverage. Documentation of eligibility
				for the purchase of MCHCP coverage shall be required prior to enrollment. A
				foster parent may enroll his/her spouse/child(ren) as long as the foster parent
				is also enrolled. In order to be eligible, a foster parent shall not have
				access to other health insurance coverage through an employer or spouse's
				employer.
(B) Dependent Coverage.
				Eligible dependents include:
1. Spouse. If
				both spouses are eligible foster parents, each spouse must enroll
				separately;
2. Children.
A. Children may be covered through the end of
				the month in which they turn twenty-six (26) years old if they meet one (1) of
				the following criteria:
(I) Natural child of
				subscriber or spouse;
(II)
				Legally-adopted child of subscriber or spouse;
(III) Child legally placed for adoption of
				subscriber or spouse;
(IV)
				Stepchild of subscriber. Such child will continue to be considered a dependent
				after the stepchild relationship ends due to the death of the child's natural
				parent and subscriber's spouse;
(V)
				Foster child of subscriber or spouse. Such child will continue to be considered
				a dependent after the foster child relationship ends by operation of law when
				the child ages out if the foster child relationship between the subscriber or
				spouse and the child was in effect the day before the child ages out;
(VI) Grandchild for whom the subscriber or
				spouse has legal guardianship or legal custody;
(VII) A child for whom the subscriber or
				spouse is the court-ordered legal guardian under a guardianship of a minor.
				Such child will continue to be considered a dependent after the guardianship
				ends by operation of law when the child becomes eighteen (18) years old if the
				guardianship of a minor relationship between the subscriber or spouse and the
				child was in effect the day before the child became eighteen (18) years
				old;
(VIII) Child of a dependent as
				long as the parent is a dependent on the newborn's date of birth. The dependent
				and the child of the dependent must remain continuously covered on the plan for
				the child of the dependent to remain eligible;
(IX) Child of a dependent when paternity by
				the dependent is established after birth as long as the parent is a dependent
				on the date the child's paternity was established The dependent and the child
				of the dependent must remain continuously covered on the plan for the child of
				the dependent to remain eligible; or
(X) Child for whom the subscriber or spouse
				is required to provide coverage under a Qualified Medical Child Support Order
				(QMCSO).
B. A child who
				is twenty-six (26) years old or older and is permanently disabled in accordance
				with subsection (5)(C) may be covered only if such child was disabled the day
				before the child turned twenty-six (26) years old and has remained continuously
				disabled.
C. A child may only be
				covered by one (1) parent if his/her parents are married to each other and are
				both covered under an MCHCP medical plan.
D. A child may have dual coverage if the
				child's parents are divorced or have never married, and both have coverage
				under an MCHCP medical plan. MCHCP will only pay for a service once, regardless
				of whether the claim for the child's care is filed under multiple subscribers'
				coverage. If a child has coverage under two (2) subscribers, the child will
				have a separate deductible, copayment, and coinsurance under each subscriber.
				The claims administrator will process the claim and apply applicable
				cost-sharing using the coverage of the subscriber who files the claim first.
				The second claim for the same services will not be covered. If a provider files
				a claim simultaneously under both subscribers' coverage, the claim will be
				processed under the subscriber whose birthday is first in the calendar year. If
				both subscribers have the same birthday, the claim will be processed under the
				subscriber whose coverage has been in effect for the longest period of time;
				or
3. Changes in
				dependent status. If a dependent loses his/her eligibility, the subscriber must
				notify MCHCP within thirty-one (31) days of the loss of eligibility. Coverage
				will end on the last day of the month that the completed form is received by
				MCHCP or the last day of the month MCHCP otherwise receives credible evidence
				of loss of eligibility under the plan.