OBSOLETE POLICY CHIP MANUAL |
Some enrollees are required to pay quarterly premiums to receive CHIP benefits.
Premium Exemptions:
Families where ALL the children receiving CHIP are verified American Indian/Alaska Native are exempt from paying the quarterly premium.
The premium IS charged if at least one child included in the CHIP coverage is not an American Indian/ Alaska Native. (See Glossary)
Due Process Month:
No premium is charged in a due process month that is initiated at review. (See Glossary)
Premium Amounts:
Families on Plan B are charged a quarterly premium of $30 per family.
Families on Plan C are charged a quarterly premium of $75 per family.
When families have children eligible for both Plans B and C, the quarterly premium will be the Plan B amount, regardless of the number of children on Plan C.
Non-Payment of Premiums:
If the family has had a decrease in income since their last application or review, they will be given the opportunity to verify their income and have their premium recalculated.
A CHIP family who does not pay their quarterly premium by the premium due date will be assessed a $15 late fee and the following will apply:
Children who are NOT verified American Indian/ Alaska Native will be removed from CHIP coverage after proper 10 day notice.
Children who ARE American Indian/Alaska Native will continue to receive CHIP.
Families who pay their past due premiums by the last day of the month immediately following the closure month can be reinstated without a lapse in coverage.
Cases closed for any reason, who re-apply within 12 months of the closure, must pay any past due premium and late fee that are owed.
If the past due premium and late fee are not paid within the time given, the application is denied.
When it has been more than 12 months since the closure, the children can enroll without paying the past due premium or late fee. The effective date of coverage can begin no earlier than the 1st day of the 13 month after closure.
Children removed from CHIP coverage for non-payment of premium, who re-apply within 12 months, must pay any past due premium and late fee that are owed.
If the past due premium and late fee are not paid within the time given, the application is denied.
When it has been more than 12 months since the child's CHIP coverage ended, the child can enroll without paying the past due premium or late fee. The effective date of re-enrollment can begin no earlier than the 1st day of the 13 month after the child was removed.
Example 1: The Jacobs family was closed January 31, 2014, because they did not pay their quarterly premium. On February 4, 2015 they reapplied for CHIP benefits. They are not required to pay the past due premium or late fee.
Example 2: The Garcia family was closed February 28, 2014, because they did not pay their quarterly premium. On February 4, 2015 they re-applied for CHIP. Because it has been less than 12 months since their closure, they must pay the outstanding premium and late fee in order to be eligible for CHIP.
If the family needs coverage for the month of February, they may want to pay the past due premiums and late fee.
If the family does not have an immediate medical need, they may choose to wait and have the CHIP eligibility start March 1, 2015, when the past due premiums and late fee would no longer be due.
Example 3: The Eaglefeather family has an open CHIP case. One adopted son, Bobby, is not a verified American Indian. The family forgot to pay the required quarterly CHIP premium and Bobby was removed from CHIP coverage as of October 31, 2013. The other 3 children on the case are verified American Indians and have remained eligible for CHIP coverage. On June 1, 2014 Mrs Eaglefeather reapplies for Bobby to be added back to the CHIP coverage.
If the past due premiums and late fee ARE PAID, Bobby will be added back to CHIP as of June 1, 2014, because it has been less than 12 months since he was removed from coverage.
If the past due premiums and late fee are NOT PAID, Bobby will NOT be able to be added back on to the CHIP coverage until November 1, 2014. By that time, the 12 months would have expired. Also