Commonwealth of Massachusetts
Executive Office of Health and Human Services
Office of Medicaid
600 Washington Street
Boston, MA  02111
www.mass.gov/masshealth

Eligibility Operations Memo 06-04
April 1, 2006



TO:	MassHealth Eligibility Operations Staff

FROM:	Russ Kulp, Director, MassHealth Operations

RE:	Medex Premium Rate Increase
		

Introduction
Blue Cross and Blue Shield of Massachusetts has received approval from 
the Division of Insurance on the following premium rates for all of its 
nongroup Medex plans:  Medex Gold, Medex Silver, Medex Standard, 
Medex Basic, Medex Bronze, Medex Core, and Medex Core Plus, 
effective March 15, 2006.
		

Rate Changes and PACES Codes
The Medex plans, PACES codes, old and new quarterly rates, and new
monthly premiums appear in the chart below.  The new monthly premium 
is the amount allowed as a patient-paid amount (PPA) deduction after
other deductions that get priority under our regulations at
130 CMR 520.026.  Fees for special billing arrangements that cause a 
premium to exceed these amounts are not allowable PPA deductions.

Important:   Correct usage of PACES codes will prevent values greater 
than the maximum premium amount from being entered.  Workers can 
enter an amount that is less than the current maximum premium amount 
to calculate a retroactive PPA.
	

Medex Plan	PACES Code	Old Quarterly 	New Quarterly	New Monthly
				Rate		Rate		Premium
Gold			3	$1,556.88	$1,788.84	$596.28
Silver			8	$1,279.26	$1,398.27	$466.09
Standard		4	$1,116.87	$1,259.43	$419.81
Basic			1	$820.86		$929.31		$309.77
Bronze			2	$414.30		$445.56		$148.52
Core			7	$232.08		$242.43		$80.81
Core Plus		6	$487.14		$474.18		$158.06
	
		
(continued on next page)

Eligibility Operations Memo 06-04
April 1, 2006
Page 2

Rate Changes and PACES Codes (cont.)
Note: The premium amount for Medex Core Plus was decreased.  
 	
Medex Basic, Gold, Silver, and Standard Plans are closed to new 
members.
		

System Changes
Community MassHealth members with Medex coding were updated 
with the new premium amounts for both MA21 and the PACES systems.  
MA21 recalculated members who have an active Medex policy.  
Members with an active Medex policy who have a deductible received a 
deductible change notice.

Long-term-care MassHealth members with Medex coding were also 
updated with the new premium amounts by the system.  MassHealth 
recalculated their PPAs in March for March 2006.
		

PPA Notices
During the month of April, MassHealth will mail system-generated 
notices containing information about the new PPAs to affected long-
term-care members, conservators, and nursing facilities.
		

Reports
The system will issue the following two reports about the Medex 
premium rate increase.

-The first report will list updated long-term-care members with their 
 old and new Medex premiums and old and new PPAs.
-The second report will be an update-exception report that identifies 
 members with Medex premiums on file that do not correspond to the 
 Medex plan for which the member is coded.
		

Questions
If you have any questions about this memo, please have your 
MassHealth Enrollment Center designee contact the Policy Hotline.