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 08-02
	February 15, 2008

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 3, 2008.

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 prevents 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 		Old			New			New
         Code			Quarterly		Quarterly 		Monthly 
						Rate			Rate 			Premium 

Gold			3			$1,949.85		$2,029.59		$676.53
Silver		8			$1,474.89		$1,494.30		$498.10
Standard		4			$1,385.37		$1,433.79		$477.93
Basic			1			$1,016.91		$1,053.45		$351.15
Bronze		2			$471.84		$487.95		$162.65
Core			7			$266.43		$263.16		$87.72
Core Plus		6			$486.45		$474.96		$158.32

(continued on next page)

Rate Changes and PACES Codes (cont.)
Medex Basic, Gold, Silver, Core Plus, and Standard Plans are closed to new 
members. The monthly premiums for Medex Core and Core Plus have decreased for 
2008.

System Changes
Community MassHealth members with Medex coding will be updated with the new 
premium amounts for both MA21 and PACES.

Long-term-care MassHealth members with Medex coding will also be updated with 
the new premium amounts by the system. MassHealth will recalculate their PPAs in 
March for March 2008.

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 PACES 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 MEC designee contact 
the Policy Hotline.