Heritage Health Insurance: Eligibility, Renewal, & BenefitsSanjoy
Heritage Health Insurance:
In this article, we will cover the basics of heritage health insurance and Nebraska’s Medicaid expansion program. If you have questions about the application process, then you can access Nebraska or the local office staff who can assist you.
After someone applies for Medicaid, DHHS will notify the applicant whether they are eligible or not. If they are not eligible for Medicaid a few things can happen depending on their circumstances.
DHHS may inform them of other programs for which they’re eligible for such as snap or food stamps, particularly for folks who are slightly over income the Medicaid application. Then the application of such folks will be sent to the Government Healthcare Department for consideration for coverage there.
As with everyone who applies for Medicaid, people who are denied eligibility can appeal DHHS’s decision, if they believe the department made a mistake. Also, they can contact the department to request a state fair hearing to begin the appeals process.
If someone is found eligible for expansion, they will receive a notice from DHHS explaining that they are eligible. Also, DHHS will explain what benefits they will receive.
Heritage Health Insurance Eligibility Criteria:
Moving forward, we will discuss some of the basic eligibility criteria. Medicaid looks at the expansion group and some of the very next steps that happen, once someone is determined to be eligible for the expansion group.
Medicaid is only looking at basic eligibility criteria like:
- Age: 19 Years to 64 Years,
- Income: At or below 138% of the federal property level,
- Residency, and
It means that they are Nebraska residents and US citizens or otherwise lawful permanent residents.
Heritage Health Insurance: Renewal Policy
Once someone is enrolled in HHA, they can be reassessed each year for eligibility without needing to send a new application to DHHS.
Heritage Health Insurance will begin these renewals automatically and let the individual know if they need to provide any updated details.
They will keep their coverage as long as they remain eligible. However, if the individual has some life circumstances changed like, maybe a raise at work or a new residential address, they will need to let DHHS know of that change within 10 days of it occurring.
When they provide these updates, DHHS staff will review their case to make sure that they are still eligible for Medicaid.
Heritage Health Insurance Benefits:
There will be two benefit packages available through heritage health insurance.
Basic and Prime Benefits:
Basic Benefits: It includes a variety of medical, behavioral, health, and prescription drug benefits.
Prime Benefits: It includes everything covered in basic plus dental, vision, and over-the-counter drug coverage.
When expansion launches in October, prime benefits will be limited to pregnant women, adults (ages 19 and 20), and those deemed medically frail by DHHS.
Note: Everyone else in this group will receive basic benefits.
How to use health heritage insurance benefit programs?
Moving on to our next topic, many people may be wondering how people in the heritage health insurance adult program will use their benefits.
All heritage health adult members will join one of the three health plans in the heritage health insurance program.
These health plans coordinate and reimburse the health services the member receives.
How does this work? Generally speaking, is that the state pays a per member per month rate to the health plans or the managed care organizations.
And these health plans are the ones that actually pay the doctor’s office or the pharmacy for the services that they provide.
Just as a couple of examples, when someone is enrolled with Medicaid they are assigned to a health plan.
Once enrolled in a health plan, members will receive an enrollment notice saying which plan they are enrolled with. This will be followed by a welcome packet from their health plan with details on how to begin.
Using their benefits, member choice is a big part of the heritage health insurance program. So, if someone wants to change their health plan, they have different opportunities to do so.
Members can change their health plans at any time. During the first 90 days, they’re on Medicaid and they can also change their health plan.
During open enrollment each year, which is from November 1st to December 15th. Just to note, open enrollment in this context is only about changing health plans.
After you are already on Medicaid, it’s not about when you can apply for Medicaid. You can apply for Medicaid at any point throughout the year.
In conclusion, it is recommended to consider a heritage health insurance program while buying health insurance for yourself. You can renew the heritage health insurance policies easily. Also, you can enjoy the basic and prime benefits of heritage health insurance.