Page 57

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

Effective Date:

Approval Date: 12-2 The State assures that enrollees have the opportunity to fully participate in the review process, whether the review is conducted in person or in writing.

The State assures that reviews, which are expedited due to an enrollee’s medical condition, are completed within 72 hours of the receipt of the request.

The State assures that reviews, except for those expedited due to an enrollee’s medical condition, will be completed within 90 calendar days of the date a request is made. (a) 12.3. Premium Assistance Programs If providing coverage through a group health plan that does not meet the requirements of 42 CFR 457.1120, please describe how the State will assure that applicants and enrollees have the option to obtain health benefits coverage other than through the Group Health Plan at initial enrollment and at each redetermination of eligibility.

Not applicable.

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Page 57

Official source

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

Effective Date:

Approval Date: 12-2 The State assures that enrollees have the opportunity to fully participate in the review process, whether the review is conducted in person or in writing.

The State assures that reviews, which are expedited due to an enrollee’s medical condition, are completed within 72 hours of the receipt of the request.

The State assures that reviews, except for those expedited due to an enrollee’s medical condition, will be completed within 90 calendar days of the date a request is made. (a) 12.3. Premium Assistance Programs If providing coverage through a group health plan that does not meet the requirements of 42 CFR 457.1120, please describe how the State will assure that applicants and enrollees have the option to obtain health benefits coverage other than through the Group Health Plan at initial enrollment and at each redetermination of eligibility.

Not applicable.