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

Effective Date:

October 1, 2009 44 Approval Date: November 19, 2010 8.6 Describe the procedures the state will use to ensure American Indian (as defined by the Indian Health Care Improvement Act of 1976) and Alaska Native children will be excluded from cost-sharing. (Section 2103(b)(3)(D)) (42CFR 457.535) If a child is identified on an application as an American Indian, the enrollment worker automatically places the child in the no-fee category if the child becomes enrolled. Therefore the insurance vendor sends an insurance card, to the family, which indicates that the child is not subject to any co-pays.

8.7 Please provide a description of the consequences for an enrollee or applicant who does not pay a charge. (42CFR 457.570 and 457.505(c)) At ten months into the enrollment period, the family is sent renewal materials which include a statement regarding any outstanding premium payment due along with the date current coverage terminates. Premium payments may be received at anytime throughout the enrollment period. However, if premiums are not paid in full by the end of the enrollment period, the child will not be eligible for renewal. An exception to this is made for families who have filed for bankruptcy during the enrollment year. At the time of renewal, if a family requests that its premium balance be forgiven, forgiveness will be granted if the family submits proof of bankruptcy status. Premiums will be removed 24 months after an enrollee’s coverage end date unless the child turned 19 while on the program in which case the premium is removed 12 months after the enrollee’s coverage end date. The state does not participate in collection action or impose benefit limitations if enrollees do not pay copayments/coinsurance.

8.7.1 Please provide an assurance that the following disenrollment protections are being applied: X State has established a process that gives enrollees reasonable notice of and an opportunity to pay past due premiums, copayments, coinsurance, deductibles or similar fees prior to disenrollment. (42CFR 457.570(a)) At one month, four months, seven months, and 10 months, families are notified of any outstanding premium payments. They are notified that premiums must be paid in full in order to renew at the end of the enrollment period.

X The disenrollment process affords the enrollee an opportunity to show that the enrollee’s family income has declined prior to disenrollment for non-payment of cost-sharing charges. (42CFR 457.570(b)) The amount of family income written on the renewal form is reviewed by enrollment workers at the time of renewal. If it is known to ALL Kids that a family is experiencing financial difficulty, the ALL Kids Social Work Consultant and/or ALL Kids Regional staff may assist