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OBSOLETE POLICY CHIP MANUAL |
Effective: September 1, 2008 - June 30, 2010
Previous Policy Reference
An individual, who has been determined eligible for CHIP, must enroll in a CHIP health plan before they can access their benefits. Molina Healthcare and Public Employees Health Plan (PEHP) have both contracted with CHIP as a health plan choice.
Enrollees, who have picked a health plan during a past CHIP enrollment and have not moved since their CHIP ended, will be automatically re-enrolled with the same health plan. Clients automatically enrolled in a plan due to past coverage, may select a new plan within 30 days by contacting their Health Program Representative (HPR).
Once approved for CHIP, the enrollee receives a PACMIS approval notice with Managed Health Care contact information. MMCS will send a separate CHIP Welcome Letter. This letter will explain that the enrollee must make a health plan selection before coverage can begin. Enrollees have 14 days, from the date of the MMCS letter, to choose one of the plans or they will be assigned to Molina.
Enrollees receive the following contact options to make their health plan choice:
A name and phone number for the Managed Health Care Health Program Representative (HPR) in their area
A toll free phone number with recorded information about benefits and how to select a health plan
Email address for their local HPR office
Information through the CHIP Website
Self return selection form included with the CHIP Member Guide
Once the health plan receives the enrollment information, the plan mails the benefit cards, provider directories and the master policy explaining co-payments and coverage information.
If an enrollee fails to make a health plan selection within 14 days from the date of the MMCS letter, they will be auto assigned. A letter is sent to inform the enrollee of his or her plan.
Enrollees who are auto assigned are allowed a maximum of 30 days to change plans. After the 30 days they are not allowed to change plans until the next health plan switch period.
The Bureau of Managed Health Care workers will provide consumer education tools and help with choosing a health plan.
Every CHIP Enrollee will receive the following education options:
CHIP Member Guide will be auto mailed once eligibility is authorized.
Access to self directed online CHIP education in both English and Spanish.
Direct phone number for the Health Program Representative (HPR) in their area.
Enrollees may request to meet with their HPR in person to learn more about their benefits. Enrollees should contact the customer service number for the selected health plan with specific CHIP coverage questions.
It will be the responsibility of the CHIP enrollee to read the member guide and other education materials provided to learn about their benefits.
Unless an enrollee has made a specific request, the HPR will not be contacting the clients directly for benefit education or health plan selection.
Health plan choice requirements and information will be included with all consumer education materials.
Under certain circumstances the enrollee may change their health plan outside of the annual ‘plan switch’ period. Enrollees should contact their local HPR with any specific requests. Enrollees must notify their local HPR before the 15th of the month in order to change their health plan for the following month.