COMMONWEALTH CARE UPDATES

"Exceptions" Process

The state has been tightening up on eligibility for individuals who appear to have access to employer health coverage. The state has begun to issue "exceptions forms" to applicants and members who may have access to other insurance, asking them to explain the circumstances surrounding their access to coverage. For example, perhaps they indicated on their application that they have had access to insurance in the past 6 months, but there was no place to indicate that they are in an employer waiting period, or they have left their job and no longer have access.

Because these exceptions forms have been confusing for patients and patient financial counselors, the state has issued a "Frequently Asked Questions" document on exceptions forms - see attached. The document addresses a number of common questions about the exceptions forms including timelines and reinstatement of benefits, and will be useful for anyone involved in assisting Commonwealth Care patients with redetermination and enrollment.

Hospital network for Commonwealth Care members

The Connector has released the Commonwealth Care hospital network - see attached. This list shows which Commonwealth Care plans each hospital in Massachusetts accepts. This is an important resource for open enrollment, happening now through June 13th. Members can use this chart to see if the hospital associated with their current providers is in the network for plans they are considering.

-Adapted from e-mail: “UPDATES: Commonwealth Care and Health Safety Net”, from Kim Simonian, MPH, Community Benefit Programs, Partners HealthCare May 11, 2008.

05/08