Page 20

Model Application Template for the State Children’s Health Insurance Program

Effective Date:

October 1, 2009 20 Approval Date: November 19, 2010 based on benefit levels alone. The ALL Kids program has a waiting period policy to deter crowd-out. Children, whose private coverage is voluntarily dropped, have to serve a 3-month waiting period before they can enroll in ALL Kids. The CHIP Data unit monitors the percentage of enrollees who have served the three- month waiting period due to voluntary termination of other coverage. There are four (4) exceptions to the waiting period policy: (1) children whose previous private coverage is through an individual policy; (2) children whose previous private coverage is through COBRA; (3) children whose previous private coverage is through the Alabama Child Caring Foundation; (4) children whose previous private coverage lifetime limits have been met. Exceptions 1, 2, and 3 were effective January 1, 2002 and exception 4 was effective July 1, 2002. The reasoning behind these exceptions is: these insurance situations are usually extremely expensive and therefore pose a true financial burden to the families (1 and 2), Child Caring insurance is very limited (3), there is essentially no real insurance coverage available to the child (4).

Applications which meet all eligibility criteria are subjected to a final review through Blue Cross Blue Shield of Alabama to check for other current insurance coverage or coverage terminated within the last 90 days. Since Blue Cross Blue Shield of Alabama covers 85% of the covered lives in Alabama, it is believed that this final review finds most of the applications where information about other insurance coverage is uncertain.

The enrollment or use of services in ALL Kids PLUS is restricted to children who are enrolled in the basic ALL Kids Program. Therefore, the information in the above three paragraphs will apply to the entire ALL Kids Program.

4.1.8. X Duration of eligibility: Eligibility for ALL Kids will commence on the first day of the month following the month of receipt of the application. An exception to this is allowed for newborns for whom coverage begins at birth when applications are received within 60 days after the birth. Two other exceptions are when Medicaid coverage ends or private insurance is involuntarily terminated. In these cases, ALL Kids coverage begins when the other insurance(s) ends so that there is no lapse in coverage for the child. Coverage for all ALL Kids enrollees is continuous for one year unless the child moves out of state or reaches the age of 19 years. Consistent with industry standards, children who become 19 years of age