Page 372

• The individual has a specific and immediate medical need, where a delay in the beginning of benefits or a temporary closure of benefits will result in not being able to get a prescription, not being able to attend a medical appointment, or loss of long-term care services prior to the premium being processed. To make recurring monthly payments via EFT, members must submit a completed Medicaid Purchase Plan Premium Member/Employer Electronic Funds Transfer form (F-13023). To make recurring monthly payments via Wage Withholding, members must submit a completed Medicaid Purchase Plan Premium Member/Employer Electronic Funds Transfer form (F-13023) and the employer must submit the Medicaid Purchase Plan Premium Employer Wage Withholding form (F- 13024). Members who are awaiting enrollment in EFT or Wage Withholding must pay their monthly premiums using another method until they receive confirmation that their EFT or Wage Withholding enrollment is complete. Members enrolled in ACCESS AutoPay or EFT or Wage Withholding will be mailed a monthly automatic premium payment reminder letter instead of a monthly premium statement. 26.5.4.2 Advance Payments Premiums may not be paid in advance. 26.5.4.3 Excess Payments The fiscal agent issues refunds if the premium was paid and is for a month in which one of the following situations occurs: 1. The individual was ineligible for MAPP. 2. The individual made an excess payment and the excess cannot be applied to the next month’s premium. 3. The member requested to close MAPP and already paid the premium for a month in which they will not be open for MAPP. The member’s estate can receive a refund if he or she dies between adverse action and the beginning of the benefit month. The fiscal agent either issues a refund or applies an excess payment to the next month’s premium if a change is reported that results in no premium or a lower premium amount. If the change is reported within 10 days of when the change occurred, the lower premium amount or $0 premium amount is effective during the month in which the change occurred. If the change is not reported within 10 days of when the change occurred, the lower premium amount or $0 premium amount is effective during the month in which it was reported. See SECTION 26.7 MAPP CHANGES for information on change reporting. Note When determining if a change was reported within 10 days of when the change occurred, the member’s reported date of change is used. If the reported date is questionable, verification may be required.