OBSOLETE POLICY CHIP MANUAL |
Any child applying for enrollment in CHIP who is enrolled (see Section 220-1) in a group health plan or other health insurance which provides “medical care” in Utah is not eligible for enrollment in CHIP. This includes:
Coverage under a parent’s or legal guardian’s employer’s health insurance plan;
Coverage under a child’s employer’s plan for a child who is employed;
Coverage under any other type of group health plan or individual health insurance plan;
Coverage under a health insurance plan through a parent who lives or works in another state when the plan covers the child in Utah. (See section 220-5)
A child who is signed up for a plan that provides medical care as defined in this section is considered enrolled in the plan the date health insurance coverage begins. The child is enrolled even if the plan has a waiting period for benefits.
Coverage under a group health plan or other health insurance plan does not have to be as comprehensive as coverage under CHIP. For example, a plan may cover only major medical expenses such as hospital, surgery, in-patient physician, and emergency services. It may not cover out-patient physician, pharmacy, lab, or immunization services. As long as the plan provides “medical care” and is not a “limited coverage plan” as defined in this section, the plan is health insurance, and the child is ineligible for CHIP enrollment.
A child enrolled in CHIP who later becomes enrolled in a group health plan or other health insurance is ineligible for CHIP. Close the case at the end of the month in which 10-day notice can be sent. Refer for an overpayment if the household did not report timely and benefits were provided beyond the month in which benefits could have been closed.