OBSOLETE POLICY CHIP MANUAL |
To apply for CHIP, individuals must complete, sign, and date a medical application or the Single Streamlined Application used to apply for all Insurance Affordability programs. Applicants have several choices of how to complete and submit an application. (See 701)
Paper application: Applicants may pick up a paper application at the eligibility agency’s local office, from the Federally Facilitated Marketplace (FFM), print one from the agency's website or ask that one be mailed to them. A paper application must be completed, signed, dated and filed at a DWS local office, the FFM, or an outreach location by delivering it in person, mailing it, or faxing it.
Telephone applications: Applicants may ask to apply by telephone. (See 701) When applying by phone, the agency will take the eligibility information over the phone then send a copy of the application form to the applicant. The applicant must sign and return the signature page to the appropriate office no later than the last day of the application processing period.
Online Applications: Applicants may complete an online application through myCase DWS online application or complete the Single Streamlined Application. When applying online, applicants must complete the online signature. The agency accepts an online signature as a legal signature of the individual applying for CHIP. The applicant can print a copy of the application, the rights and responsibilities, and other important information provided for their own records.
Review Form: If an individual or household is currently open for public assistance, a review form may be used as an application for another type of assistance, or for a new household member. The individual must indicate on the form what type of assistance is being requested, who the household wants to cover, and the date of the request. The review form with the request must be delivered to a local agency office. If the individual has not previously signed a medical assistance application and completed appropriate assignment of rights and third party liability information, the agency will send this information to the applicant to complete, sign and return. If the review closed for failure to complete the review process, the review form can be used to re-apply if received by the eligibility agency within 90 days after the closure. See 704
Verbal Request: An applicant who has a pending application for other types of assistance may make a verbal request to add CHIP to the application.
The applicant must make the verbal request while the application for other assistance is still pending and within 30 days of the application date of the pending application. If the 30th day is a non-business day, the applicant has until the first business day following the 30th day to make the verbal request. The date the applicant makes the request to add CHIP is the date of application for medical assistance.
If the agency has approved or denied the application for other assistance, or if it is more than 30 days after the application date, the applicant must submit a new application.
An unsigned application is not complete and the agency cannot determine eligibility until it receives the signature. The applicant must return the signed signature page no later than the last day of the application processing period or the agency will deny the application. (See Sec. 701 on filing an application and Sec. 701-1 on how the agency sets the application date.)
If an application is not complete, the agency will contact the applicant and offer ways for the applicant to complete the application. The application must be completed by the end of the application processing period, or the application will be denied.