County of San Diego Health and Human Services Agency HHSA County Medical Services CMS Program Guide Other Coverage Number Page 0701 1 of 1 Background Applicants are required to report entitlement to OHC Applicants will be asked to use other available health coverage CMS is the payer of last resort CMS does not pay insurance premiums deductibles or copayments Veterans are encouraged to use all medical services available to them through the Veterans Administration A CMS recipient must reimburse CMS from any settlement received for health care services provided by CMS for which another party may be responsible Policy A Other Health Coverage OHC Applicants indicating that they have other health care coverage which does not meet the MEC requirement under ACA must complete the Health Insurance Questionnaire CMS69 at initial application recertification and reapplication as a condition of eligibility Veterans must complete the CMS69 if they have other health care coverage through private insurance Prior to the approval of CMS benefits Have the applicant complete the CMS69 Check for completeness of the form and verify that a phone number for the insurance company isgiven the policyholders social security number is provided and the form is signed and dated Scan the form into AuthMed Send the original CMS 69 to the ASO at PO Box 927110 San Diego CA 92192 B Third Party Liability TPL A CMS recipient must reimburse CMS from any settlement received including a settlement from the recipients own insurance for health care services provided by CMS for which another party may be responsible eg vehicle accident job injuries injuries caused by a third partys action TPL Report CMS7 The Third Party Liability Report CMS7 report is used to ensure that all necessary information is reported to CMS and acknowledges the recipients responsibility to reimburse the CMS program The CMS7 is part of the permanent case record It is not necessary to complete the report if the applicant received a settlement before applying for CMS has spent the money and now qualifies for CMS The applicant must fill out the CMS7 as fully as possible The completed form is sent to ORR for processing Other Program Impact None References None Sunset Date This policy will be reviewed for continuance by August 31 2022 Release Date August 14 2015