HEALTH SAFETY NET (HSN) ELIGIBILITY & OTHER INSURANCE
PROGRAM	HSN COVERAGE	HSN RETROACTIVE COVERAGE	HSN COST SHARING	OTHER COST SHARING NOTES
Comprehensive MassHealth (Standard, CommonHealth, Family Assistance Direct Coverage)	Not eligible for HSN	No retroactive HSN   Still have 10 days retroactive MassHealth	Not applicable	MassHealth co-pays of $1 and $3 for pharmacy
MassHealth Basic and Essential	Only have HSN for 10 days prior and 90 days post application date (if the patient does not choose a PCC site, then the state is supposed to autoassign him to one after 2 weeks)*   The 10 day retroactive HSN coverage is only for medical services NOT for pharmacy		$1 and $3 HSN co-pays for pharmacy while in the HSN period before MassHealth coverage begins	MassHealth co-pays of $1 and $3 for pharmacy
Non comprehensive MassHealth (Limited, Healthy Start, CMSP)	Have HSN Secondary for non-covered services	Have 6 month HSN retroactive coverage   Retroactive HSN coverage is only for medical services NOT for pharmacy	$1 and $3 HSN co-pays for pharmacy
Commonwealth Care	New applicants only have HSN for 10 days prior and 90 days post application (Plan Type 1 applicants will be autoassigned to a plan after 2 weeks if they have not selected one on their own) *   The 10 day retroactive HSN coverage is only for medical services NOT for pharmacy If the patient (Plan Type 2 and 3) has not selected a plan after 90 days, then he is terminated and becomes self pay. If he then enrolls and selects a plan, he has HSN until his plan becomes effective on the first day of the month (there is NO 10 day HSN retroactive coverage in this case)   Once Plan Type 2 and 3 members enroll in a Commonwealth Care plan, they have HSN for dental only.		$1 and $3 HSN co-pays for pharmacy while in the HSN period before Commonwealth Care coverage begins   Once enrolled, Plan Type 2 members can use HSN for dental services with no cost sharing   Plan Type 3 members must pay an HSN –Partial deductible both when they are in the HSN period before their Commonwealth Care coverage begins (except for Rx) and for dental services once they are enrolled.   Deductible amounts: Between 201%-250% FPL, deductible is $41 Between 251%-300% FPL, deductible is $2,083	Practices should be able to view patients’ Commonwealth Care co-pay requirements on their insurance cards, or in the same systems that are used to find co-pay requirements for privately insured patients.   Commonwealth Care co-pays are not shown in REVS
Private insurance (employer plans, Commonwealth Choice, student health plans, MassHealth Premium Assistance)	Have HSN Secondary for non-covered services	Have 6 month HSN retroactive coverage   Retroactive HSN coverage is only for medical services NOT for pharmacy	Have HSN for private insurance deductibles and co-insurance   HSN will NOT cover private insurance co-pays	Practices that see patients with private insurance and HSN should collect the private insurance co-pays
Medicare	Have HSN Secondary for non-covered services	Have 6 month HSN retroactive coverage   Retroactive HSN coverage is only for medical services NOT for pharmacy	Have HSN for co-pays, deductibles and co-insurance
HSN only	HSN Primary	Have 6 month HSN retroactive coverage   Retroactive coverage is only for medical services NOT for pharmacy	$1 and $3 HSN co-pays for pharmacy

 

* If the required verifications are submitted later than 60 days from the application date, 10 days HSN retroactive coverage will begin at the date of determination, rather than application..

9/30/08

 

Community Benefits Programs