Top 10 Reasons
Why MCHA Applications are Pended for Additional Information

1. Request for Pre-existing Condition Limitation Waiver: COBRA affordability.

Required information is missing when applicant requests pre-existing condition limitation waiver under reason #3, “I was unable to afford or continue to afford my premiums for COBRA or other continuation coverage under a similar state law.”

Required information/documentation:

a. The date prior coverage terminated – Certificate of Prior Creditable Coverage form with COBRA termination date.

b. COBRA premium information – Documentation from the employer or prior COBRA health insurance carrier identifying the COBRA premium rate.

2. Request Pre-existing Condition Limitation Waiver: Exhausted COBRA or Continuation.

Required information is missing when applicant requests the pre-existing condition limitation waiver under reason #2, “I have exhausted my continuation coverage under COBRA or other continuation coverage under a similar state law.”

Required information/documentation:

a. The date prior coverage terminated – Certificate of Prior Creditable Coverage.

b. Information on the date COBRA benefits were exhausted – Letter from the employer or prior COBRA health insurance carrier with the date COBRA was exhausted.

3. Request Pre-existing Condition Limitation Waiver:

Required information is missing when applicant requests any other waiver.

Required information/documentation:

a. The date prior coverage terminated-Certificate of Prior Creditable Coverage.

b. The reason prior coverage was terminated – A letter is needed from the prior health insurance carrier or employer stating the reason why coverage ended.

4. Agent Certification of Health-Related Rejection: Minnesota licensed health insurance agents can certify that an applicant is not eligible for coverage with another insurance carrier. When applying under application section “H. Eligibility: 4. Health Related Rejection item (b), agents do not fully complete the corresponding section “Agent Certification of Health Related Rejection” (section L.)

Required Information/documentation: If an agent is certifying the applicant is not eligible for coverage under another carrier, the agent must fully complete section “L. Agent Information: Agent Certification of Health-Related Rejection” and must sign/date this section. Agent letters are accepted only if the letter includes the same information required in section L (medical condition and date of diagnosis/name and address of attending physician/name and address of insurer that will not accept the applicant for coverage) and the letter is signed and dated by the agent.

5. Health Insurance Carrier Rejection: When applying under application section “H. Eligibility: #4. Health-Related Rejection (a), the insurance carrier information is outdated or does not provide health rejection/benefit reduction information.

Required information/documentation: The rejection letter must include the name of the health insurance company that issued the denial. It must be dated within the last six months and must include the medical or health-related condition for which the applicant was rejected.

6. Proof of Minnesota Residency: Applicant does not include the required proof of Minnesota residency as required in section “C. Residency.”

Required information/documentation: The applicant is required to provide one acceptable form of documentation verifying Minnesota residency and dated within 6 months prior to the date of application. Refer to the Instructions for Application (Section C.) for information on acceptable forms of documentation.

7. Automated Clearing House (ACH) Bank Account Information Missing: The applicant does not include a voided check or savings account deposit slip, when completing section “K. Premium Billing Options,” ACH Authorization Agreement.

Required information/documentation: The applicant must attach a copy of a voided check or savings account deposit slip for future ACH premium payments. A checking account deposit slip is not acceptable. MCHA does not assume that the ACH process should be set up under the same account number listed on the check used to pay the initial premium payment.

8. ACH (Automated Clearing House) Authorization Agreement: When choosing the monthly premium billing option, within section “K. Premium Billing Options,” the applicant does not complete the ACH Authorization Agreement.

Required information/documentation: If the applicant chooses to pay premiums monthly, MCHA requires the applicant to use the ACH. The applicant must complete and sign the ACH Authorization Agreement and must attach a copy of a voided check or savings account deposit slip for future ACH premium payments. A checking account deposit slip is not acceptable. MCHA does not assume that the ACH process should be set up under the same account number listed on the check used to pay the initial premium payment.

9. Incorrect Premium Payment Submitted: The applicant does not include the correct amount to cover the initial MCHA premium due.

Required information/documentation: The applicant must include the correct amount to cover their initial premium payment. The amount must correspond to the correct premium amount listed on the current MCHA premium rate sheet for the plan option selected, individual’s age and his/her use or non use of tobacco. The premium amount must correspond to the premium billing option selected (monthly or quarterly premium billing).

10. No Premium Payment Submitted: Applicant did not include an initial MCHA premium payment.

Required information/documentation: The applicant must include the correct amount to cover their initial MCHA premium payment. The amount must correspond to the correct premium amount listed on the current MCHA premium rate sheet for the plan option selected, the individual’s age and his/her use or non use of tobacco. The premium must also correspond to the premium billing option selected (monthly or quarterly premium billing).