Policy History for  5.16.5 Benefit Period

rELEASE 05-01

5.16.5 Benefit Period

The benefit period for SC is 12 consecutive months.  The benefit period and eligibility remain intact unless the participant :
 

  1. Moves out of state,

  2. Reapplies (5.16.11),

  3. Requests to withdraw from the program (5.16.12.1), or

  4. Dies.

5.16.5.1 ID Cards

When an applicant is found eligible for SC, s/he is mailed a plastic SeniorCare ID card and information about how to use it.  SC participants who renew their eligibility will continue to use their original card.

5.16.5.2 Eligibility Begin Date

SC begins on the first day of the month following the month in which all eligibility requirements have been met.

 

Exception:  SC eligibility begins the day after MA eligibility ends if a SC application is submitted prior to the MA termination date and all eligibility requirements are met.

 

Example 1:  Carol applies for SC on September 19th and meets all eligibility requirements.  Her application is processed on October 10th, and eligibility is confirmed the same day.  Carol’s benefit period is from October 1st through September 30th.

 

Example 2:  William applied for SC on September 19th but did not submit the enrollment fee with his application.  His eligibility “pends” and a notice is issued.  William submits the fee on October 1st and eligibility is confirmed the same day.  William’s benefit period is from November 1st through October 31st.

 

Example 3:  Mary is notified that MA eligibility will end on November 30th because her assets exceed the limit.  She applied for SC on November 29th and will meet all SC eligibility requirements on December 1st (when she is no longer an MA recipient).  Mary’s benefit period is from December 1st through November 30th.

 

This page last updated in Release Number: 04-02

Release Date: 04/30/04

Effective Date: 04/30/04