Re-application for Primary Care Benefits 

Examine the Completed Sample Application for Primary Care Benefits.

           Each month, the Enrollment Coordinator will receive a list of those CAP enrollees whose re-enrollment is due.         

  1. Determine that the CAP Enrollee still meets the CAP eligibility criteria:
a) Federal Poverty Level (FPL) at or below 200%,
  b) Enrollee is 18 or more years of age and less than 65 years of age, and
c) Enrollee is not insured & not eligible for insurance (i.e., Medicaid, Medicare).
  1. Complete or update your organization's Sliding Fee Application to determine the current total household size and total monthly household income and thereby the FPL.

  2. If the patient still meets the eligibility criteria in a, b and c, enter the Enrollee name (First, Middle Initial and Last) and the Social Security Number onto the CAP Application for Primary Care Benefits as shown in the completed sample.

  3. The Application form is available in Microsoft Word format.  Add  your corporation's name at the top of the Application form, before you make copies.

  4. Ask the CAP enrollee to read, sign and date the Enrollment, Authorization or Release portion of this Application.  

  5. Witness this signature by signing and dating the form yourself. 

  6. Check the form for completeness and legibility.

  7. Store the completed form in accordance with the policies of your organization.

  8. Complete a new Patient Financial Statement. Instructions have been previously provided.

  9. Update the Health History screen on the CAP Data Entry web site (alternatively complete a new Health History scan form and send it to the CAP IS Coordinator). Instructions are provided.

  10. ONLY IN THE EVENT THAT THE SLIDING FEE OR HOSPITAL ELIGIBILITY HAVE CHANGED, issue a NEW  membership card to the re-enrollee  (Example, on re-enrollment, the CAP member's income has gone down such that she now has Hospital Eligibility, whereas at initial enrollment she did not qualify for Hospital Eligibility because of her income).

  11. Check the proper block Clinic "Eligible for SF (Sliding Fee) Yes or No and write in the FPL determined by completing the Sliding Fee Application on the back of the card, .

  12. Check the block " Hospital Eligibility" either Yes or No.  If the Patient Financial Statement indicates that the CAP Enrollee is eligible, the correct response is "Y" for Yes. Write in the FPL you determined by completing the Patient Financial Statement.

  13. Examine your work, laminate the CAP membership card and present it to the CAP Enrollee.

  14. Complete a new  CAP Health History data page by using the CAP Data Entry web site or send the completed CAP Health History scan form to the CAP IS Coordinator

  15. Provide re-enrolling CAP member an SF-8 CAP Health Survey Form (scan form). Ask the member to complete each question and return the form in the self-addressed and stamped envelope.

  16. IF THE MEMBER HAS ONE OR MORE CHRONIC CONDITIONS, complete a new Chronic Conditions Data page by using the CAP Data Entry web site or send the completed Chronic Conditions Data scan sheet to the CAP IS Coordinator.

          You have completed the CAP Re-enrollment process!