The only life event changes (LECs) that are eligible for payment are those that result in new coverage for a consumer who is changing applicant status or adding a brand-new household member. Unfortunately, LECs that result in program changes (i.e., Insurance Assistance to Medical Assistance; MinnesotaCare to Medical Assistance) via income changes or any other LECs are not eligible for payment. Only submit case associations for applicant status or adding new member LECs.

Example Scenarios

Situations that are not eligible for payment and a case association should NOT be submitted:

• My client is unassisted QHP (UQHP) due to having access to employer sponsored coverage (ESI). I report to MNsure that ESI has ended. After the change, my consumer is eligible for MinnesotaCare.
• My client was Insurance Assistance. I report that she is pregnant now and her income has decreased. After the change, the consumer is eligible for Medical Assistance.

Situations that are eligible for payment and a case association SHOULD be submitted:

• My client gets married. I report adding the wife that did not have coverage previously.
• My client has a baby. I report that baby.
• My client’s husband was on the application but not as an applicant. I call to change him from a non-applicant to an applicant.

More details on what activities are eligible for payment are included in the /assister-central/navigator-one-stop/policy-procedures/navigator-payment-policy.jspNavigator Payment Policy . Be sure to look through the /assister-central/navigator-one-stop/policy-procedures/nav-payment-faq.jspfrequently asked questions for additional scenarios. We also suggest reviewing the /assister-central/navigator-one-stop/policy-procedures/assister-case-association-policy.jspNavigator Case Association Form Policy.