22 CSR 10-2.110
General Foster Parent Membership Provi
sions
PURPOSE: This rule establishes the policy of the board of trustees
in regard to the general membership provisions for foster parents
covered under the Missouri Consolidated Health Care Plan.
(1) Terms and Conditions. This rule provides the terms and con
ditions 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 cancella
tion processes, whether by online, written, or verbal communi
cation. 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 en
rollment. 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 sub
scriber’s spouse;
(V) Foster child of subscriber or spouse. Such child will
continue to be considered a dependent after the foster child re
lationship 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 de
pendent 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 depen
dent to remain eligible; or
(X) Child for whom the subscriber or spouse is re
quired 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 si
multaneously 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 thir
ty-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 re
ceives credible evidence of loss of eligibility under the plan.
(3) Enrollment Procedures.
(A) An eligible foster parent must enroll for coverage within
thirty-one (31) days from the date of the letter notifying the
foster parent of his/her eligibility to enroll. If enrolling spouse/
child(ren), proof of eligibility must be submitted as defined in
section (5).
(B) An eligible foster parent may elect coverage and/or
change coverage levels during the annual open enrollment
period.
(C) An eligible foster parent may elect or change coverage for
himself/herself and/or for his/her spouse/child(ren) if one (1) of
the following occurs:
1. Occurrence of a life event, which includes marriage,
birth, adoption, and placement of child(ren). A special enroll
ment period of thirty-one (31) days shall be available beginning
with the date of the life event. It is the eligible foster parent’s
responsibility to notify MCHCP of the life event;
A. If paternity is necessary to establish the life event and
was not established at birth, the date that paternity is estab
lished shall be the date of the life event; or
2. Employer-sponsored group coverage loss. An eligible fos
ter parent or his/her spouse/child(ren) may enroll within sixty
(60) days due to an involuntary loss of employer-sponsored cov
erage under one (1) of the following circumstances:
A. Employer-sponsored medical, dental, or vision plan
terminates;
B. Eligibility for employer-sponsored coverage ends;
C. Employer contributions toward the premiums end; or
D. Consolidated Omnibus Budget Reconciliation Act
(COBRA) coverage ends; or
3. If an eligible foster parent or his/her spouse/child(ren)
loses MO HealthNet or Medicaid status, s/he may enroll in an
MCHCP plan within sixty (60) days of the date of loss; or
4. If an eligible foster parent or eligible foster parent’s
spouse receives a court order stating s/he is responsible for cov
ering a child, the eligible foster parent may enroll the child in
an MCHCP plan within sixty (60) days of the court order; or
5. Default Enrollment
A. If an eligible foster parent is enrolled in the PPO
750, PPO 1250, or HSA Plan and does not complete enrollment
during the open enrollment period, the foster parent and his/
her dependents will be enrolled in the same plan enrolled in
the prior year at the same level of coverage; or
B. If an eligible foster parent is enrolled in dental and/
or vision coverage and does not complete open enrollment to
cancel coverage or change the current level of coverage during
the open enrollment period, the foster parent and his/her de
pendents will be enrolled at the same level of coverage in the
same plan(s), effective the first day of the next calendar year; or
6. If an eligible foster parent submits an Open Enrollment
Worksheet or an Enroll/Change/Cancel form that is incomplete
or contains obvious errors, MCHCP will notify the foster parent
of such by mail, phone, or secure message. The foster parent
must submit a corrected form to MCHCP by the date enrollment
was originally due to MCHCP or ten (10) business days from the
date MCHCP notifies the foster parent, whichever is later.
(4) Effective Date Provisions. In no circumstances can the effec
tive date be before the eligibility date or before January 1, 2013.
The effective date of coverage shall be determined, subject to
the effective date provisions as follows:
(A) Eligible Foster Parent and Dependent Effective Dates.
1. Unless stated otherwise by these rules, an eligible foster
parent and his/her eligible dependents’ effective date of cov
erage is the first of the month coinciding with or after the el
igibility date. Except for coverage being added due to a birth,
adoption, or placement of children, the effective date of cover
age cannot be prior to the date of receipt of the enrollment by
MCHCP.
2. The effective date of coverage for a life event shall be as
follows:
A. Marriage.
(I) If a subscriber enrolls and/or enrolls his/her spouse
before a wedding date, coverage becomes effective on the
wedding date subject to receipt of proof of eligibility. The
monthly premium is not prorated.
(II) If an eligible foster parent enrolls within thir
ty-one (31) days of a wedding date, coverage becomes effective
the first of the month coinciding with or after receipt of the
enrollment form and proof of eligibility, unless enrollment is
received on the first day of a month, in which case coverage is
effective on that day;
B. Newborn.
(I) If a subscriber or eligible foster parent enrolls an
eligible newborn within thirty-one (31) days of birth date, cov
erage becomes effective on the newborn’s birth date.
(II) If a subscriber or employee enrolls an eligible
spouse and/or children within thirty-one (31) days of the birth
of the newborn, coverage becomes effective on the newborn’s
birth date or the first of the month after enrollment is received,
subject to proof of eligibility. The monthly premium will not
be prorated.
(III) If a subscriber does not elect to enroll a newborn
of a dependent child within thirty-one (31) days of birth, s/he
cannot enroll the dependent of a dependent at a later date;
C. Child where paternity is established after birth. If a
subscriber enrolls a child due to establishment of paternity
within thirty-one (31) days of the date paternity is established,
coverage becomes effective on the first day of the next month
after enrollment is received, unless enrollment is received on
the first day of a month, in which case coverage is effective on
that day;
D. Adoption or placement for adoption.
(I) If a subscriber or eligible foster parent enrolls an
adopted child within thirty-one (31) days of adoption or place
ment of a child, coverage becomes effective on the date of
adoption or placement for adoption.
(II) If a subscriber or employee enrolls an eligible
spouse and/or children within thirty-one (31) days of an adop
tion or placement for adoption, coverage may become effec
tive on the date of adoption or date of placement for adoption,
or the first of the month after enrollment is received, subject to
proof of eligibility. The monthly premium will not be prorated;
E. Legal guardianship and legal custody.
(I) If a subscriber or eligible foster parent enrolls a
child due to legal guardianship or legal custody within thir
ty-one (31) days of guardianship or custody effective date,
coverage becomes effective on the first day of the next month
after enrollment is received, unless enrollment is received on
the first day of a month, in which case coverage is effective on
that day;
F. Foster care.
(I) If a subscriber or eligible foster parent enrolls a
foster child due to placement in the subscriber or eligible
foster parent’s care within thirty-one (31) days of placement,
coverage becomes effective on the first day of the next month
after enrollment is received, unless enrollment is received on
the first day of a month, in which case coverage is effective on
that day; or
G. Eligible Foster Parent.
(I) If an eligible foster parent enrolls due to a life
event, the effective date for the eligible foster parent is the first
day of the next month after enrollment is received, unless en
rollment is received on the first day of a month, in which case
coverage is effective on that day.
(II) If the life event is due to a birth, adoption, or
placement of child(ren), coverage becomes effective on the
newborn’s birth date, date of adoption, or date of placement
for adoption. The monthly premium will not be prorated.
3. An eligible foster parent who elects coverage and/or
changes coverage levels for him/herself and his/her spouse/
child(ren) or dependents during open enrollment shall have an
effective date of January 1 of the following year.
4. If a foster parent gains state employment, s/he must en
roll as a new state employee.
5. Coverage is effective for a dependent the first of the
month coinciding with or after the Qualified Medical Child
Support Order is received by the plan or date specified by the
court.
(5) Proof of Eligibility. Proof of eligibility documentation is
required for all dependents and subscribers, as necessary.
Enrollment is not complete until proof of eligibility is received
by MCHCP. A subscriber must include his/her MCHCPid or Social
Security number on the documentation. If proof of eligibility is
not received, MCHCP will send a letter requesting it from the
subscriber. Except for open enrollment, documentation must
be received within thirty-one (31) days of the date MCHCP
processed the enrollment, or coverage will not take effect for
those individuals whose proof of eligibility was not received.
MCHCP reserves the right to request that such proof of eligibil
ity be provided at any time upon request. If such proof is not
received or is unacceptable as determined by MCHCP, coverage
will terminate or never take effect. If enrolling during open
enrollment, proof of eligibility must be received by November
20, or coverage will not take effect the following January 1 for
those individuals whose proof of eligibility was not received. If
invalid proof of eligibility is received, the subscriber is allowed
an additional ten (10) days from the initial due date to submit
valid proof of eligibility.
(A) When enrolling a newborn child, the subscriber must no
tify MCHCP of the birth verbally or in writing within thirty-one
(31) days of the birth date. MCHCP will then send an enrollment
form and letter notifying the subscriber of the steps to initiate
coverage. The subscriber is allowed an additional ten (10) days
from the date of the plan notice to return the enrollment form.
Coverage will not begin unless the enrollment form is received
within thirty-one (31) days of the birth date or ten (10) days
from the date of the notice, whichever is later. Newborn proof
of eligibility must be submitted within ninety (90) days of the
birth date. If proof of eligibility is not received, coverage will
terminate on day ninety-one (91) from the birth date.
(B) Acceptable forms of proof of eligibility are included in the
following chart:
(C) An eligible foster parent and his/her spouse/child(ren)
enrolling due to a loss of employer-sponsored group coverage.
The foster parent must submit documentation of proof of loss
within sixty (60) days of enrollment. Failure to provide the
required documentation within the above stated time frames
will result in the foster parent and his/her spouse/child(ren)
being ineligible for coverage until the next open enrollment
period.
(D) The eligible foster parent is required to notify MCHCP on
the appropriate form of the spouse/child’s name, date of birth,
eligibility date, and Social Security number.
(E) Disabled Dependent.
1. An eligible foster parent may enroll his/her permanently
disabled child when first eligible or an enrolled permanently
disabled dependent turning age twenty-six (26) years, may
continue coverage beyond age twenty-six (26) years, provided
the following documentation is submitted to the plan prior to
the end of the month of the dependent’s twenty-sixth birthday
for the enrolled permanently disabled dependent or within
thirty-one (31) days of enrollment of the permanently disabled
child:
A. Evidence from the Social Security Administration
(SSA) that the permanently disabled dependent or child was
entitled to and receiving disability benefits prior to turning
age twenty-six (26) years; and
B. A benefit verification letter dated within the last
twelve (12) months from the SSA confirming the child is still
considered disabled.
2. If a disabled dependent over the age of twenty-six (26)
years is determined to be no longer disabled by the SSA, cover
age will terminate the last day of the month in which the dis
ability ends or never take effect for new enrollment requests.
3. Once the disabled child’s coverage is cancelled or termi
nated, s/he will not be able to enroll at a later date.
Circumstance
Documentation
Addition of
biological child(ren)
Government-issued birth certificate or other government-issued or legallycertified proof of paternity listing subscriber as parent and child’s full name and
birth date
Addition of stepchild(ren)
Marriage license to biological or legal parent/guardian of child(ren); and
government-issued birth certificate or other government-issued or legallycertified proof of eligibility for child(ren) that names the subscriber’s spouse as a
parent or guardian and child’s full name and birth date
Addition of foster
child(ren)
Order of placement
Adoption of
dependent(s)
Order of placement; or
Filed petition for adoption listing subscriber as adoptive parent
(documentation must be received with the enrollment forms) and
final adoption decree or birth certificate issued (documentation must be received
within thirty-one (31) days of the date the court enters a final decree of adoption)
Legal guardianship
or legal custody of
dependent(s)
Court-documented guardianship or custody papers (Power of Attorney is not
acceptable)
Addition of a
child(ren) of covered
dependent
Government-issued birth certificate or legally-certified proof of paternity for the
child(ren) listing dependent as parent with child’s full name and birth date
Marriage
Marriage license or certificate recognized by Missouri law
Divorce
Final divorce decree; or
Notarized letter from spouse stating s/he is agreeable to termination of coverage
pending divorce or legal separation
Death
Government-issued death certificate
Loss of MO
HealthNet or
Medicaid
Letter from MO HealthNet or Medicaid stating who is covered and the date
coverage terminates
MO HealthNet
Premium Assistance
Letter from MO HealthNet or Medicaid stating member is eligible for the
premium assistance program
Qualified Medical
Child Support Order
Qualified Medical Child Support Order
Prior Group
Coverage
Letter from previous insurance carrier or former employer stating date coverage
terminated, length of coverage, reason for coverage termination, and list of
persons covered
(6) Termination.
(A) Unless stated otherwise, termination of coverage shall
occur on the last day of the calendar month coinciding with or
after any of the following events, whichever occurs first:
1. Failure to make premium payment for the cost of cov
erage. If MCHCP has not received payment of premium at the
end of the thirty-one- (31-) day grace period, the subscriber and
his/her dependents will be retroactively terminated to the date
covered by his/her last paid premium. The subscriber will be
responsible for the value of services rendered after the retroac
tive termination date, including, but not limited to, the grace
period;
2. Loss of foster parent licensure as determined by the
Department of Social Services;
3. With respect to dependents, upon divorce or legal sep
aration from the subscriber or when a dependent is no longer
eligible for coverage. A subscriber must terminate coverage for
his/her enrolled ex-spouse and stepchild(ren) at the time his/
her divorce is final;
A. When a subscriber drops dependent coverage after
a divorce, s/he must submit a completed form, a copy of the
divorce decree, and current addresses of all affected depen
dents. Coverage ends on the last day of the month in which the
divorce decree and completed form are received by MCHCP or
MCHCP otherwise receives credible evidence of a final divorce
that results in loss of member eligibility under the plan;
4. Death of dependent. The dependent’s coverage ends on
the date of death;
5. A member’s act, practice, or omission that constitutes
fraud or intentional misrepresentation of material fact;
6. A member’s threatening conduct or perpetrating violent
acts against MCHCP or an employee of MCHCP;
7. A subscriber has obtained access to other health insur
ance coverage through an employer or spouse’s employer; or
8. A member otherwise loses benefit eligibility.
(B) MCHCP may rescind coverage due only to non-payment
of a premium, fraud, or intentional misrepresentation. MCHCP
shall provide at least thirty (30) days written notice before it
rescinds coverage.
(C) Termination of coverage shall occur immediately upon
discontinuance of the plan, subject to the plan termination
provision specified in 22 CSR 10-2.080(1).
(D) If a member receives covered services after the termina
tion of coverage, MCHCP may recover the contracted charges
for such covered services from the subscriber or the provider,
plus its cost to recover such charges, including attorneys’ fees.
(E) Termination of a foster parent’s coverage shall terminate
the coverage of dependents.
(7) Voluntary Cancellation of Coverage.
(A) A subscriber may cancel medical coverage, which will be
effective on the last day of the month in which the subscriber
notifies MCHCP to cancel coverage.
1. A subscriber may reinstate medical coverage after a
voluntary cancelation by submitting an Enroll/Change/Cancel
form prior to the end of current coverage.
(B) If a member receives covered services after the voluntary
cancellation of coverage, MCHCP may recover the contracted
charges for such covered services from the subscriber or the
provider, plus its cost to recover such charges, including attor
neys’ fees.
(C) A subscriber cannot cancel medical coverage on his/her
dependents during divorce or legal separation proceedings un
less s/he submits a notarized letter from his/her spouse stating
s/he is agreeable to termination of coverage pending divorce.
(D) A subscriber may only cancel dental and/or vision cover
age during the year for themselves or their dependents if they
are no longer eligible for coverage or when new coverage is
taken through other employment.
(8) Federal Consolidated Omnibus Budget Reconciliation Act
(COBRA).
(A) Eligibility. In accordance with COBRA, eligible foster
parents and their dependents may temporarily continue their
coverage when coverage under the plan would otherwise end.
Coverage is identical to the coverage provided under MCHCP to
similarly-situated eligible foster parents and family members.
If members cancel COBRA coverage, they cannot enroll at a
later date.
1. Eligible foster parents voluntarily or involuntarily end
ing licensure as a foster parent (for reasons other than gross
misconduct) may continue coverage for themselves and their
covered dependent(s) for eighteen (18) months at their own ex
pense.
2. If a subscriber marries, has a child, or adopts a child
while on COBRA coverage, subscriber may add such eligible
spouse/child(ren) to the subscriber’s plan if MCHCP is notified
within thirty-one (31) days of the marriage, birth, or adoption.
The subscriber may also add his/her eligible spouse/child(ren)
during open enrollment.
3. Dependents may continue coverage for up to thirty-six
(36) months at their own expense if the covered foster parent
becomes eligible for Medicare.
4. A surviving dependent, who has coverage due to the
death of an eligible foster parent, may elect coverage for up to
thirty-six (36) months at their own expense.
5. A divorced or legally-separated spouse and stepchild(ren) may continue coverage at their own expense for up
to thirty-six (36) months.
6. Child(ren) who would no longer qualify as dependents
may continue coverage for up to thirty-six (36) months at their
(or their parent’s/guardian’s) expense.
7. If the Social Security Administration determines a
COBRA member is disabled within the first sixty (60) days of
coverage and the disability continues during the rest of the ini
tial eighteen (18) month period of continuation of coverage, the
member may continue coverage for up to an additional eleven
(11) months.
8. If the eligible member has Medicare prior to becoming
eligible for COBRA coverage, the member is entitled to cover
age under both.
(B) Premium Payments.
1. Initial payment for continuation coverage must be re
ceived within forty-five (45) days of election of coverage.
2. After initial premium payment, MCHCP bills on the last
working day of the month. There is a thirty-one- (31-) day grace
period for payment of regularly scheduled monthly premiums.
3. Premiums for continued coverage will be one hundred
two percent (102%) of the total premium for the applicable cov
erage level. Once coverage is terminated under the COBRA pro
vision, it cannot be reinstated.
(C) Required Notifications.
1. To be eligible for COBRA, the subscriber or applicable
member must notify MCHCP of a divorce, legal separation, a
child turning age twenty-six (26), or Medicare entitlement
within sixty (60) days of the event date.
2. The Department of Social Services Children’s Division
will notify MCHCP when a foster parent is no longer eligible.
3. If a COBRA participant is disabled within the first sixty
(60) days of COBRA coverage and the disability continues for
the rest of the initial eighteen- (18-) month period of continu
ing coverage, the affected individual must notify MCHCP that
s/he wants to continue coverage within sixty (60) days, start
ing from the latest of: 1) the date on which the SSA issues the
disability determination; 2) the date on which the qualifying
event occurs; or 3) the date on which the qualified beneficiary
receives the COBRA general notice. The affected individual
must also notify MCHCP within thirty-one (31) days of any final
determination that the individual is no longer disabled.
(D) Election Periods.
1. When MCHCP is notified that a COBRA-qualifying event
has occurred, MCHCP notifies eligible members of the right to
choose continuation coverage.
2. Eligible members have sixty (60) days from the date of
coverage loss or notification from MCHCP, whichever is later, to
inform MCHCP that they want continuation coverage.
3. If eligible members do not choose continuation cover
age within sixty (60) days of lost coverage or notification from
MCHCP, coverage ends.
(E) Continuation of coverage may be cut short for any of
these reasons:
1. The state of Missouri no longer provides group health
coverage to foster parents;
2. Premium for continuation coverage is not paid on time;
3. The covered foster parent or dependent becomes cov
ered (after the date s/he elects COBRA coverage) under another
group health plan that does not contain any exclusion or lim
itation with respect to any pre-existing condition s/he may
have;
4. The covered foster parent or dependent becomes enti
tled to Medicare after the date s/he elects COBRA coverage; or
5. The covered foster parent or dependent extends cover
age for up to twenty-nine (29) months due to disability and
there has been a final determination that the individual is no
longer disabled.
(9) Missouri State Law COBRA Wrap-Around Provisions.
(A) Missouri law provides that if a member loses group health
insurance coverage because of a divorce, legal separation, or
the death of a spouse, the member may continue coverage
until age sixty-five (65) under two (2) conditions:
1. The member continues and maintains coverage under
the thirty-six- (36-) month provision of COBRA; and
2. The member is at least fifty-five (55) years old when
COBRA benefits end. The qualified beneficiary must apply to
continue coverage through the wrap-around provisions and
will have to pay the entire premium. MCHCP may charge up to
an additional twenty-five percent (25%) of the applicable pre
mium.
(B) For a member to continue coverage under this subsec
tion, a member must either—
1. Within sixty (60) days of legal separation or the entry of
a decree of dissolution of marriage or prior to the expiration
of a thirty-six- (36-) month COBRA period, the legally-separated
or divorced spouse who seeks such coverage shall give MCHCP
written notice of the qualifying event, including his/her mail
ing address; or
2. Within thirty (30) days of the death of a foster parent
whose surviving spouse is eligible for continued coverage or
prior to the expiration of a thirty-six- (36-) month COBRA pe
riod, the human resource/payroll representative or the surviv
ing spouse shall give MCHCP written notice of the death and
the mailing address of the surviving spouse.
(C) Within fourteen (14) days of receipt of the notice, MCHCP
shall notify the legally-separated, divorced, or surviving spouse
that coverage may be continued. The notice shall include:
1. A form for election to continue the coverage;
2. The amount of premiums to be charged and the method
and place of payment; and
3. Instructions for returning the elections form by mail
within sixty (60) days after MCHCP mails the notice.
(D) Continuation of coverage terminates on the last day of
the month prior to the month the subscriber turns age six
ty-five (65). The right to continuation coverage shall also termi
nate upon the earliest of any of the following:
1. The state of Missouri no longer provides group health
coverage to foster parents;
2. Premium for continuation coverage is not paid on time;
3. The date on which the legally-separated, divorced,
or surviving spouse becomes insured under any other group
health plan;
4. The date on which the legally-separated, divorced, or
surviving spouse remarries and becomes insured under an
other group health plan; or
5. The date on which the legally-separated, divorced, or
surviving spouse reaches age sixty-five (65).
(10) Medicare.
(A) Members who are eligible for Medicare benefits under
Part A, B, or D must notify MCHCP of their eligibility and pro
vide a copy of the member’s Medicare card within thirty-one
(31) days of the Medicare eligibility date. If Medicare coverage
begins before turning age sixty-five (65), the member will
receive a Medicare disability questionnaire. The member
must return the completed questionnaire to MCHCP for the
Medicare eligibility to be submitted to the medical vendor.
(B) If a member enrolls in a Medicare Part D plan in addi
tion to coverage under this plan, Medicare Part D becomes
the member’s primary plan. Such member’s benefit must be
adjusted in order for the plan to avoid liability for filing claims
under the subsidy reimbursement portion of Medicare Part D.
This plan will pay primary with appropriate copayments or
coinsurance when the member is within the Medicare Part D
coverage gap.
(11) Communications to Members.
(A) It is the foster parent’s responsibility to ensure that
MCHCP has current contact information for the member and
any dependent(s).
(B) A foster parent must notify MCHCP of a change in his/her
mailing or email address as soon as possible, but no later than
thirty-one (31) days after the change.
(C) It is the responsibility of all foster parents who elect to
receive plan communication through email to ensure plan
emails are not blocked as spam or junk mail by the member or
by the member’s service provider.
(D) Failure to update a mailing or email address may result in
undeliverable mail/email of important informational material,
delayed or denied claims, loss of coverage, loss of continuation
rights, missed opportunities relating to covered benefits, and/
or liability for claims paid in error.
(12) Deadlines. Unless specifically stated otherwise, MCHCP
computes deadlines by counting day one (1) as the first day
after the qualifying event. If the last day falls on a weekend or
state holiday, MCHCP may receive required information on the
first working day after the weekend or state holiday.
(13) Premiums. Notwithstanding any other rule to the contrary,
foster parents are responsible for paying the entire actuarial
determined rate of total premium with no employer or MCHCP
contribution.
(14) Members are required to disclose to the claims administra
tor whether they have other health coverage and, if so, infor
mation about the coverage. Once the information is received,
claims will be reprocessed subject to all applicable rules.
AUTHORITY: sections 103.059 and 103.078, RSMo 2016.* Emergency
rule filed Aug. 28, 2012, effective Oct. 1, 2012, terminated Feb. 27,
2013. Original rule filed Aug. 28, 2012, effective Feb. 28, 2013.
Amended: Filed Oct. 30, 2013, effective June 30, 2014. Emergency
amendment filed Oct. 29, 2014, effective Jan. 1, 2015, terminated
May 30, 2015. Amended: Filed Oct. 29, 2014, effective May 30, 2015.
Emergency amendment filed Oct. 28, 2015, effective Jan. 1, 2016,
expired June 28, 2016. Amended: Filed Oct. 28, 2015, effective May
30, 2016. Emergency amendment filed Oct. 28, 2016, effective
Jan. 1, 2017, expired June 29, 2017. Amended: Filed Oct. 28, 2016,
effective May 30, 2017. Emergency amendment filed Oct. 31, 2018,
effective Jan. 1, 2019, expired June 29, 2019. Amended: Filed Oct. 31,
2018, effective May 30, 2019. Emergency amendment filed Oct. 30,
2019, effective Jan. 1, 2020, expired June 28, 2020. Amended: Filed
Oct. 30, 2019, effective May 30, 2020.
*Original authority: 103.059, RSMo 1992 and 103.078, RSMo 2012.