Public Authority Insurance Termination Policy & Procedures

Purpose: To identify the conditions and timelines under which IHSS Providers will have their insurance coverage initiated and terminated.

Objective: To allow providers with coverage a reasonable amount of time to meet the minimum hourly requirements before insurance is terminated and to offer providers on the waiting list insurance coverage in a timely manner.

Initiating Insurance Coverage

1. To qualify for insurance, IHSS providers must work a minimum of 75 hours per month for 3 consecutive months. This is the Minimum Required Hours (MRH) methodology.
   1. Hours are averaged over a three month period. For example, those providers who work for multiple recipients and have fluctuating hours might work 70 hours one month, 80 hours the next, and 75 the next. This would average to 75 hours over the past 3 months.
   2. Once qualified, providers must contact the Public Authority to apply for insurance or request to be put on the waiting list.
   3. If providers are placed on the waiting list, they must continue to meet the RMH in order to apply for insurance when it becomes available.
   4. Providers may not place their name on the waiting list in anticipation of gaining the appropriate number of hours. The requirements must be met before their name will be placed on the list.
2. When a slot becomes available for insurance, the Public Authority staff will contact the first provider on the waiting list by sending a letter offering insurance. If the provider does not respond within two weeks, a call will also be made offering the insurance.
   1. The provider will have 30 days to apply for insurance from the date the offer letter is mailed. If we do not have contact from the provider, the provider will forfeit their place on the list and the next provider on the waiting list will be contacted.
   2. If the provider contacted our office within the 30 day time frame, but an application was not completed, the provider will be sent a warning letter giving them 30 additional days to enroll. If they do not complete paperwork within the time frame stated in the warning letter, they will forfeit their place on the list and the next provider on the waiting list will be contacted.
   3. If a provider on the waiting list does not meet the MRH at the time a slot becomes available, a warning letter will be sent giving them 30 days to show an increase in hours. Because they do not meet the MRH however, the available slot will be offered to the next person on the waiting list.
      1. If the provider is able to show reasonable proof that their hours will meet the minimum requirement within 30 day deadline, they will be returned to their original position on the waiting list.
   4. If a provider on the waiting list does not meet the hourly requirement by the 30 day deadline, they will be removed from the list and must meet all the initial insurance eligibility requirements before being placed back on the list. Their name will be placed at the bottom of the waiting list at the time of re-enlistment.

Terminating Insurance Coverage

1. Once a provider has obtained insurance coverage through IHSS, they are responsible for notifying the Public Authority if they no longer wish to receive the insurance due to a qualifying event. If they do not contact Public Authority, they are responsible for the premium payments until termination occurs, and may be billed for the monthly premium.
2. The Public Authority will continually monitor the hours for each provider receiving insurance. The providers will be required to maintain the MRH to continue receiving insurance through IHSS.
3. A Provider may voluntarily terminate their own insurance under the following conditions:
   1. They drop below the RMH, and request that the Public Authority discontinue their insurance immediately to avoid being billed for the monthly premiums.
   2. They have a qualifying event. Examples of a qualifying event are: marriage (in which the provider is now eligible under a spouse’s plan) and becoming eligible for Medicare.
   3. A provider moves out of state.
   4. During open enrollment.
4. If a provider drops below the MRH and does not notify the Public Authority, they will be sent a warning letter stating the have 45 days to increase hours or they will lose their insurance.
   1. If the payroll system shows the provider has increased their hours to the MRH within the deadline given, they will not be terminated.
   2. If the provider does not show an increase in hours before the deadline, they will be terminated from the insurance program and will receive notification from COBRA informing them of their options to continue their insurance.
   3. The timeline from the date of the warning letter to the date of termination shall not be less than two months.
   4. If a provider contacts Link2Care with evidence their hours have increased, Link2Care may extend the deadline with proof of hours. This extension of insurance shall be limited to one month from the initial deadline date. This is at the sole discretion of the Public Authority.