Effective Date: April 1, 2023 - December 31, 2023
Previous Policy (Quarterly Premiums)
Previous Policy (Cost Sharing Exemptions)
Most CHIP members have cost sharing requirements with some exceptions. Cost sharing includes deductibles, co-payments and quarterly premiums. The amount the member is required to pay is determined by which CHIP benefit plan they qualify for (600).
Most CHIP members are required to pay quarterly premiums to receive CHIP benefits. The premium amount is a set amount for each CHIP plan, no matter how many children in the household are covered on CHIP. The member will receive an invoice every 3 months (quarterly) informing them when their premiums are due.
The quarterly premium amount for CHIP plan B is $30 per family
The quarterly premium amount for CHIP plan C is $75 per family
Families that have children who qualify for both plans, the quarterly premium will be for the lower cost CHIP for all the children.
The premium is charged if at least one child included in the CHIP coverage is not an American Indian/ Alaska Native.
Members are not required to pay premiums for a due process month. (See Glossary)
Members can choose any of the following options to pay their quarterly premiums:
Online at: https://jobs.utah.gov/mycase/
By phone: 1-866-435-7414
By Mail:
Department of Workforce Services
Business Office
PO Box 143250
Salt Lake City Utah 84114
If the premium is not paid by the due date, a $15 late fee will be charged to their account and the CHIP benefits will end effective the month for which the agency can give proper 10-day notice.
o Children included on CHIP that are verified American Indian/Alaska Native will continue to receive CHIP as they are exempt from cost sharing.
Members are required to pay past due premiums and late fees in order to reinstate the child’s CHIP coverage with the following exceptions:
o It has been more than 3 months from when the CHIP coverage ended.
o The member reports a decrease in income and is determined eligible for Medicaid.
If the past due premiums and late fees are paid by the last day of the month following the closure month, the CHIP coverage will be reinstated without a lapse in coverage.
If the member reapplies and is determined eligible, the child can enroll in CHIP without paying the past due premiums and late fees if it has been more than 3 months since the CHIP coverage ended.
Example 1: The Rodriguez family was receiving CHIP for Alexis & Clint. They didn’t pay the CHIP premium by the due date and CHIP closed January 31, 2017. They reapplied for CHIP on May 5, 2017.
They are not required to pay the past due premiums or late fees because it has been more than 3 months. The CHIP can begin no earlier than May 1, 2018.
Example 2: The Patric family was receiving CHIP for Allen & Kassandra. They didn’t pay the CHIP premium by the due date and CHIP closed February 28, 2017. On April 4, 2017 they re-applied for CHIP.
They are required to pay the outstanding premium and late fees because it has been less than 3 months since the CHIP closed. The CHIP can begin no early than April 1, 2018.
Example 3: The Maganda family has an open CHIP case for their children Linda, Cathy, Julieta & Pogi. All of the children except for Pogi are verified American Indian. The family forgot to pay the required quarterly CHIP premium and Pogi was removed from CHIP coverage as of January 31, 2018. Because the other 3 children on the case are verified American Indian they remain eligible for CHIP coverage. On March 1, 2018. Ms. Maganda reapplies for Pogi to be added back to the CHIP coverage.
They are required pay the outstanding premium and late fees because it has been less than 3 months since the CHIP closed. The CHIP can begin no early than March 1, 2018.
Most CHIP members are required to pay co-payment and deductibles for medical and dental services. Copayments and deductibles are types of cost sharing fees the member is required to pay for services covered by their health plan.
A copayment is a fixed amount the member is required to pay for covered health care services and can vary by the type of covered services. The amount of the co-payment depends on which plan the member qualifies for (600).
A deductible is the amount the member is required to pay for covered health services before the health plan begins to pay.
Members can view co-payment information and the types of services that require a co-payment at: www.health.utah.gov/chip/resourcematerials.htm.
Individuals enrolled in CHIP are not required to pay more than 5% of the household’s countable income for out of pocket expenses during the certification period. The maximum amount is per family, not per child. DHHS's payment system keeps track of the member's incurred expenses including their out of pocket maximum for each certification period.
If a 5% disregard was applied in the calculation of countable income, the amount of income before applying 5% disregard is the income used to determining the out of pocket maximum.
The eligibility system will calculate the maximum out of pocket amount for co-payments and deductibles the member will be required to pay for the certification period. The CHIP approval and renewal notices will include the maximum out of pocket amount. The member is still required to pay their quarterly premiums.
Example: The member’s annual countable income is $25,800 and the household was approved for CHIP plan B. They are required to pay a quarterly premium of $30 ($120 annual). To determine their out of pocket maximum, take the total annual income and multiply that by .05 then subtract their annual premium amount.
$25,800 times .05 = $1290 minus the annual premium of $120 = $1170.
Once the household has met their annual co-pay and deductible maximum, they no longer have to pay co-pays or deductibles for that benefit period.
o If the Out of Pocket Maximum has been met and a due process month is issued, the co-pay and deductible exemptions are extended in the due process month(s).
Verified American Indian/Alaska Native individuals are not required to pay co-payments, deductibles or quarterly premiums. The tribe must be recognized by the Federal government. The definition of who is an American Indian/Alaska Native is defined by the tribe.
o See Table VI for acceptable verification of American Indian/Alaska Native Status and how to verify if the tribe is recognized by the United States Bureau of Indian Affairs.
Applicants: Allow CHIP coverage with the cost sharing exemption when an individual declares to be an American Indian/Alaska Native, and there is no evidence that contradicts their claim.
o Give the individual reasonable time to provide documentation of their status. "Reasonable time" is at least 30 days. A member may request more time if needed.
o If the individual has been given reasonable time and does not provide the documentation or proof that they are working on obtaining it, remove the exemption with proper 10- day notice.
Recipients: Request proof of American Indian/Alaska Native status at review if their status was self-declared at application and tribal verification has not yet been provided.
o Give the member reasonable time to provide documentation of their status. “Reasonable time” is at least 30 days. A member may request more time if needed.
o If the member fails to provide the verification or proof that they are working on obtaining it, remove the exemption with proper 10 day notice.
If verification of a person's American Indian/Alaska Native status is received at any time, allow the exemption starting the month verification is received.
o The member will be refunded any premiums paid during the 12 months prior to the month of verification.