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REV. MAY 3, 2018 NEBRASKA DEPARTMENT OF MEDICAID ELIGIBILITY MANUAL LETTER #43-2018 HEALTH AND HUMAN SERVICES 477-000-026

477-000-026 – Basic Budgetary Allowance for Non-MAGI

Medical Deductions: Verify medical insurance policies and document the following: 1. Name and address of insurance company; 2. Type of coverage; 3. Policy number; 4. Premium amount; 5. Effective dates of coverage; and 6. Policy owner and individual(s) covered.

Primary Sources

a. The insurance policy; b. Contact with the insurance company; c. Premium notice; d. Contact with the employer; e. Blue Cross Blue Shield TPL alert (the premium amount cannot be verified with this alert if it is employer sponsored health insurance); f. Contact with the policy owner, if other than the client; or g. Cancelled checks for health insurance premiums.

Examples: Considered Health Insurance

The following examples ARE considered health insurance. These policies provide or require specific medical or health service. Data should be entered on N-FOCUS/TPL and premium deductions allowed

Example 1: Physicians Mutual Insurance; hospital daily indemnity policy; monthly premium of $15; pays $25 per day for every day hospitalized.

Example 2: Amex Life Insurance; nursing home confinement policy; monthly premium of $52.20; pays $20 per day for every day of nursing home confinement for a maximum of twenty-four months.

Example 3: Bankers Life and Casualty Co.; cancer treatment policy; monthly premium of $5.60; pays for cancer surgery and chemotherapy.

NOTE: See 477 NAC 12-005 or 477 NAC 12-006 and 477 NAC 22-003.02F for treatment of Third Party Medical Payments received directly.