A redet is not applicable if offset (reduction in benefits) is not continuous for
any reason, such as a break in offset due to a high ACE. However, these rules must
be modified when there is change in the family composition, such as a subsequently
entitled auxiliary with a DIB MOE after the date of the first potential redet. See
following example.
04/1993
|
NH entitled (no auxiliaries).
Offset postponed due to high ACE.
This is the Offset First Considered Date
|
04/1994
|
WC rate increases.
NH’s DIB reduced due to WC offset; offset continues.
This is the Offset Effective Date. .
|
01/1997
|
Redet due based on Offset Effective Date (redet due in 1997, three calendar years
from 1994, the year benefits are first reduced due to WC offset).
Redet applies (higher benefits payable after offset for the NH).
|
01/1998
|
HC1 entitled (family composition change).
|
We presume that if HC1 had been entitled in 04/1993, they would have been in partial
offset effective 04/1993.
To determine rates payable for the family effective 01/1998 (HC1’s MOET), we must recompute offset retroactively to 04/1993 as though HC1 was entitled in 04/1993
(the month offset was first considered).
-
a.
The fictitious rates payable result in no offset for the NH for 04/1993-03/1994 and
the NH’s benefits are offset effective 04/1994. HC1 is offset effective 04/1993 so
this creates a fictitious Offset Effective Date of 04/1993. Therefore, a fictitious
redet is computed for 01/1996, three calendar years after the new (but fictitious)
04/1993 Offset Effective Date.
-
b.
We must do a reconciliation of the future redet schedule between the prior family
composition (NH only entitled) and the new family composition (NH and HC1 entitled)
at the point the new family composition becomes effective (HC1 becomes entitled in
01/1998) to adhere to the every third year rule for redets. In this example, after
the month of the family composition change (01/1998), any future redets are based
on the year offset was actually first imposed (the actual offset effective date of 04/1994).
-
c.
The fictitious rates payable after offset for 04/1993-12/1997 are computed to determine
the amount payable to the NH and HC1 beginning 01/1998, the date of the family composition change. Therefore, the amounts previously determined
payable after offset for the NH for 04/1993-12/1997 (prior to HC1’s entitlement) do
not change.Actual benefits are not offset for 04/1993 through 03/1994.
-
d.
The NH’s actual benefits are offset effective 04/1994. Therefore, as long as there is no break in
offset from the actual Offset Effective Date (04/1994), actual redets are due in 01/1997, 01/2000, 01/2003, 01/2006, etc., at three-year intervals.
Use the fictitious Offset Effective Date of 04/1993 and the fictitious redet in 01/1996
only to compute the rates payable beginning 01/1998 (HC1’s MOET).
The ACE DATA output screen (WCAC) in ICF displays the fictitious redet ACE (01/96)
as well as the actual redet ACEs (01/97, 01/00, 01/03, 01/06). The following illustrates
the WCAC screen for this example:
WC/PDB OFFSET - ACE DATA WCAC
|
NH SSA: 9999999999
|
EFF (MMYY)
|
ACE
|
80% ACE
|
TYPE
|
METHOD
|
ACE BASE YEAR(S)
CCYY-CCYY |
REDET CONTROL YEAR (CCYY)
|
0493
|
2500.00
|
2000.00
|
ORIGINAL
|
INPUT
|
|
0493
|
0196
|
2775.00
|
2220.00
|
TRI REDET
|
|
|
0493
|
0197
|
2670.00
|
2136.00
|
TRI REDET
|
|
|
0494
|
0100
|
3120.00
|
2496.00
|
TRI REDET
|
|
|
0494
|
0103
|
3557.00
|
2845.60
|
TRI REDET
|
|
|
0494
|
0106
|
3852.00
|
3081.60
|
TRI REDET
|
|
|
0494
|
The first two entries on this screen (04/93, 01/96) only apply to the fictitious computations
(due to the family composition change) and therefore display the fictitious Offset
Effective Date of 04/93 in the last column.
NOTE: Save ICF computations that include a “fictitious period” as a Pre-Adjudicate with
an explanation in the Special Instructions Field on the WCDP (Disposition) screen.
For example: “The computation results for MM/YYYY – MM/YYYY are fictitious due to
a family composition change (see DI 52150.080I). Actual amounts payable after offset begin MM/YYYY.”