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State Children’s Health Insurance Program

Phase 1 Effective Date: April 1, 1998

Revised: 1/26/98, 2/19/98, 3/3/98, 3/6/98 Phase 2 Effective Date: July 1, 1998

Revised: 8/20/98, 8/24/98, 10/1/99, 7/28/00, 1/31/01, 7/02/02, 7/22/02, 1/3/03, 2/13/04, 9/27/04, 11/15/04, 8/11/05, 10/1/06, 7/1/09, 7/1/10, 7/1/11, 7/1/12 105 Upon receipt of the application and proof of federally recognized tribe status, Healthy Kids will identify and flag the child's account as an AI/AN account. Once an account has been flagged as an AI/AN account, the system will not require premiums to be paid on the account, will not cancel the account for non-payment, will not generate late notices, etc., provided that the child meets all other Title XXI criteria in order to qualify for waiver of premium.

For example, a child who presented acceptable tribal documentation to qualify as AI/AN but whose household income is at 300% FPL will NOT qualify for a premium waiver. As long as there is at least ONE active AI/AN child in a family of multiple children, the $15 or $20 monthly premium will be waived for all. If the AI/AN child ceases to be active, then the other children will have to resume monthly payments. Children whose accounts have been flagged as AI/AN accounts will receive a letter which states that they are exempt from cost-sharing, which the children can present to their providers to be exempted from any required co-payments, if applicable.

8.6 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))

Under state law, families who do not make their monthly premium payments on time will be disenrolled from coverage and will not be eligible for reinstatement for a minimum of 30 days. Premium payments are due on the first day of the month of coverage and are considered late after that date. Families receive a coupon book upon initial enrollment that indicates the amount of the monthly premium and the day the premium is due for each month. Families are given the opportunity to make late premium payments during the 30 day grace period. If premium payments to FHKC are not received by the seventh day of the month prior to coverage, they are considered late and the families receive written notification that they will be canceled at the end of the month, and the consequences of cancellation. If a payment is posted to the wrong account, or if another error caused by FHKC or its TPA causes a child’s coverage to be canceled, FHKC will reactivate the coverage. If the TPA has not received a premium payment for a child during the grace period coverage for that child will be canceled. The family will receive written notification of that cancellation.