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Missouri Application for the State Children’s Health Insurance Program Proposed Effective Date: 05/01/2009 Approval Date:
Prior Approval Date: 09/28/2007 - 27A - unions, credit unions, church affiliations, other organizations, or individual policies. The HIPP Program is the same program the State currently uses. There have been no changes implemented in the HIPP Program. The State will provide employer-sponsored insurance (ESI)/HIPP coverage for the SCHIP 2 children and those in the SCHIP 1 program when it is determined to be cost effective. When a HIPP application is received the information is verified by contacting the employer for group policies or the insurance company if it is an individual policy. It is necessary to verify the amount of the premium, how often it will be paid, and whether the premium is payroll deducted or paid directly to employer or insurance company. The benefit package is reviewed for deductibles, copays, and coinsurance amounts that the policyholder would be responsible for. The effective date of the policy and the claims address are verified by contacting the insurance company. The application is then processed in the HIPP system to determine cost effectiveness of the policy and the policy holder is notified of the determination by letter. The HIPP application is processed in the HIPP system to determine cost effectiveness of the policy by entering the peer grouping information into the system. The peer grouping information includes age, gender, Medical Eligibility Code (ME Code), county code, and the coverage code for the policy. The system determines the average cost of healthcare that was expended in the previous year for each Medicaid recipient in that group. The system then compares that information with the Group Health Plan costs which includes the annual premium amount, annual policy deductibles, and annual coinsurance amounts. As part of the HIPP application process, the HIPP system compares the services provided under the Group Health Plan, including exclusions for pre-