Entering Health Insurance Data – TAFDC

Health Insurance

The Health Insurance page captures information about any basic health insurance coverage and benefits an applicant or client (hereafter referred to as client) has.  Information about the insurance subscriber is entered on the Policy tab and benefit information is entered on the Benefits tab. The information on this page indicates availability of benefit coverage, which must be used before using MassHealth. Fields on this page capture data about the health insurance policy, subscriber, benefits and premiums.

The Health Insurance page in the Assessed Person Income and Expenses Workflow, is enabled any time a Yes answer is given to the Health Insurance question in the Income and Expenses Q & A Navigator. It remains enabled so that new health insurance information can be entered at any time.

Note: If the client has no health insurance, the No Health Insurance checkbox will be checked on this page if the client stated he or she had no health insurance in the application interview.

The Health Insurance page has two tabs:

  • Policy tab; and
  • Benefits tab

Health Insurance Policy Tab

Use this tab to collect insurer details, policy details and subscriber data.

You must ask clients who receive SSI and/or RSDI about Medicare Part D participation at reapplication and at recertification. All beneficiaries eligible for Medicare Part A and/or enrolled in Medicare Part B are entitled to the Medicare Part D prescription drug benefit.

Medicare Part A is available to all clients who receive SSI and RSDI benefits as well as those who receive RSDI only, if they are otherwise income and asset eligible. However, individuals who receive RSDI only generally must receive this benefit for 24 months before becoming eligible for Medicare, or until they become 65 years old, whichever comes first. There are certain other circumstances where an individual may receive Medicare Part A before age 65 and without a waiting period.

Add Insurer and Subscriber Data on the Policy Tab

  1. access the Health Insurance Page. The policy tab is selected by default
  2. for the Insurer, click the Insurer Pop-up icon. The pop-up displays a list of insurers. Select an insurer from the drop-down list. The selected Insurer will appear in the Insurer field.  
  3. for Type, select the type of health insurance:
    1. Family, or
    2. Individual
  4. for Policy Number, enter the health insurance policy number
  5. for Group Number, enter the health insurance policy group number
  6. for Subscriber, click the pop-up button next to the middle name field to open the Household Member/Basic Person list page. This page lists all the members of the household. Select the member who is the subscriber for the insurance policy by clicking the check box to the left of the name.

    1. Note: The first, last, middle names and the Social Security number of this person will display as a default in the subscriber field of the Policy tab. The relationship of this person will also be displayed and defaults to whatever was previously selected on the Relationship page. If the person you selected is the subscriber, Self will display in the Relationship field.

  7. if the subscriber is not displayed in the Household Member/Basic person list, enter the person’s SSN, first, last and middle names in the appropriate fields.Select the relationship of the person to the grantee from the drop-down list
  8. for Monthly Premium Amount, enter the monthly premium amount for the health  insurance policy

    1. Note: BEACON adds a decimal point only for whole dollar amounts (if $40 is entered, BEACON adds the decimal point and it will show as $40.00).  You will need to add a decimal point when entering expenses that are not a whole dollar amount. ExampleExampleIf a weekly payment of $40.50 is made and is entered as 4050, BEACON will add a decimal point and make the amount $4050.00.

  9. for Premium Effective, type in the premium effective date or select the date from the pop-up calendar
  10. for Premium Payer, click select and select one or more premium payers from the following drop-down list:
    1. Absent parent
    2. Civil service
    3. Employer
    4. Federal
    5. Parent
    6. Private Third Party
    7. Railroad
    8. Self
    9. State
    10. Union
  11. click the Benefits tab to complete the benefit field (see instructions for completing Benefits tab)

Complete the Benefits Tab

Use this tab to collect benefit data for an insurer.  If you change the insurer, the benefits on the Benefits page will be removed for that record.

Add Insurance Benefits on the Benefits tab

  1. click the Benefits tab
  2. for Benefit Type, select a type of benefit from the following drop-down list:
    1. Basic Health
    2. Dental
    3. Drug; or
    4. Medicare Extension
  3. for Start and End, enter the start and end dates, as appropriate. You can select dates from the pop-up calendar or type in the dates
  4. to save the data in both the Benefits tab and the Policy tab, click Save
  5. to enter information for a new benefit tab click Clear and repeat steps 3-5. To add more benefits to the record, add a new row by clicking the Add-a-Row icon and follow steps 2-4. To delete a row, click the Delete-a-Row icon next to the row

Related Topics

Employment Policy and Procedures

Last Update: November 13, 2015