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

Effective Date:

Approval Date: 24 plan coverage. Records are reviewed to ensure that the two-month period of ineligibility policy is applied appropriately. Action is taken as needed. Trends are monitored to ensure that the policy is consistently applied throughout the programs.

4.1.8.

Duration of eligibility: Eligibility is for 12 continuous months, unless one of the following events occurs before the annual renewal: 1) moves out of state; 2) obtains other health insurance; 3) a child turns age 19; 4) the family requests cancellation; 5) the family applies for Medicaid and the child is determined eligible for Medicaid or 6) if the child is enrolled in a HKC plan and does not pay the premium. Families with HKC children will have a minimum 30 days to pay their portion of the premium before being disenrolled. People in HKC are billed by OPHP each month for their portion of the premium. OPHP combines the member’s portion with the subsidy and pays the insurance carrier. Individuals who fail to pay their premium will be disenrolled. Members are billed approximately 45 days in advance of the date premiums are due to the carrier. Members are provided a premium grace period of at least 30 days from the billing date. Reminder notices are mailed mid-way through this grace period. Subsidy cancellation notices outlining the program’s intent to terminate, are mailed at the end of the grace period. Terminated individuals can be reinstated on a one time exception basis. Once terminated for non payment of premium members are able to re-enroll in the program. In order to do so, however, they must serve a new two-month period of uninsurance

Eligibility is redeterminded every twelve months for State Plan

children (at or below 200% FPL). No limit to duration of eligibility if

all conditions are met. The Unborn population is eligible for CHIP

benefits while in utero and redetermined at birth. Coverage for this

population is restricted to counties referenced in 4.1.1.

4.1.9.

Other standards (identify and describe): Although eligibility is retroactive to date of CHIP application, the client is not eligible if the application does not include selection of a prepaid health plan in mandatory managed care areas for OHP Plus coverage. This is the same as the current rule applied to OHP Medicaid non-categorical members. The twelve-month eligibility period for Healthy KidsConnect members begins on the date of application approval. Plan enrollment will be no earlier than the first of the month following