OBSOLETE POLICY CHIP MANUAL |
Resource
Co-Payments and Deductibles
CHIP recipients, with certain exceptions, are required to pay co-payments and deductibles.
Deductibles must be paid only for specific services.
Some families are exempt from CHIP cost-sharing. (See 601-3)
Out-of-Pocket Maximums
The maximum dollar amount in co-payments, deductibles and quarterly premiums an individual is required to pay per certification period is no more than 5% of the individual’s total annual countable income (412-4) that was used to determine eligibility for the certification period. If the 5% disregard was applied in the calculation of countable income, the amount of income before the application of the 5% disregard is the income used when determining the out of pocket maximum.
The maximum is per family, not per child.
The eligibility system calculates the maximum amount by multiplying the individual’s countable income by 5% and enters it on the CHIP approval and renewal notices.
When there are children in the household who would qualify for both Plan B and Plan C, the Plan B premium, deductibles, co-pays and out-of-pocket maximum will apply for all children.
Table II lists services which are generally covered by CHIP, the co-payment and deductible requirements, and some of the limitations for certain services.
Covered services may change at any time, so the list may not always be up-to-date.
To find out if a particular service that a client needs is covered, enrollees should call their health and dental plans.
Families are responsible to track the amount of deductibles and co-payments they pay. The eligibility system does not keep track automatically.
When a household thinks they have met or exceeded their family out-of-pocket maximum, they should contact the CHIP administrative office (currently Justin Wadman, 801-538-6445, jwadman@utah.gov).
Whenever there is a reported change of income during the certification period, the worker must educate the client about how the out-of-pocket maximum could be affected. For example, if lower income is reported, the out-of-pocket maximum would go down. It may not be an advantage to the household that has nearly met their current out-of-pocket maximum.