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Revision 15-4; Effective October 1, 2015
CHIP
Households are eligible to change health plans for any reason up to 90 calendar days after the enrollment start date. There is no limit to the number of times a household may change plans within that time frame. In addition, households may change health plans once per year at redetermination for any reason or during the child’s enrollment segment for specific reasons.
The household may request and complete a health plan transfer:
by phone,
in writing using the Enrollment/Transfer form submitted by fax or mailed to:
HHSC PO Box 149023 Austin, TX 78714-9023
by Interactive Voice Response (IVR), or
online using YourTexasBenefits.com .
CHIP Perinatal
Households are eligible to change health plans for any reason up to 120 calendar days after the enrollment start date. There is no limit to the number of times a household may change plans within that time frame. Households may change health plans during the enrollment segment for specific reasons.
The household may request and complete a health plan transfer:
by phone,
in writing using the Enrollment/Transfer form submitted by fax or mailed to:
HHSC PO Box 149023 Austin, TX 78714-9023
by IVR, or
online using YourTexasBenefits.com .
Related Policy
Plan Change During Current Enrollment Segment, D-1741
D—1741 Plan Change During Current Enrollment Segment
Revision 15-4; Effective October 1, 2015
CHIP, CHIP Perinatal
Following the first 90 days of CHIP enrollment or 120 days for CHIP perinatal, a household is allowed to change health plans during the child's enrollment segment if the household:
permanently relocates to a different health maintenance organization service delivery area.
permanently relocates to a different location within a service area and this relocation would necessitate a change in primary care provider.
has good cause to request a plan change. A household's request to change health plans on the basis of good cause can be approved in limited situations, and HHSC determines the situations that constitute good cause.
is unable to receive the service the member is seeking because the plan does not cover the service because of moral or religious objections.
needs related services (for example, a cesarean section and a tubal ligation) to be performed at the same time; not all related services are available within the network; and the member's primary care provider or another provider determines that receiving the services separately would subject the member to unnecessary risk.
has other reasons, including but not limited to, poor quality of care, lack of access to services covered under the contract, or lack of access to providers experienced in dealing with the member's health care needs.
A household may submit a request for a health plan change or disenrollment to the Enrollment Broker, who reviews and considers each request on an individual basis. If the household disagrees with the decision, the household may request a review. The household, health plan and Enrollment Broker receive notification from HHSC regarding disposition of the review.
D—1742 Plan Change at Redetermination
Revision 15-4; Effective October 1, 2015
Households can change health plans once per year during redetermination.
If the household’s request for a health plan change is received by the cutoff date of the last month of the child's certification period, the ECN letter is sent to inform the household of the new health plan selection.
For a household with health plan change information processed after the cutoff date of its last month of certification, a grace period extends to the cutoff date of the first month of the child's new certification period. The household's CHIP coverage continues under the original health plan through the end of the first month of the child's new certification period. Coverage under the new health plan begins the first day of the following month. The household is sent the Health Plan Transfer (HCC) letter informing the household of the new health plan selection.
Health plan change requests received by the Enrollment Broker as part of the redetermination process are applied to the new certification period and do not affect the current certification period, unless the requests are submitted due to a change of address or other good cause reason.
Once the health plan change form is received and processed, additional enrollment health plan changes are granted for address changes and other good cause reasons only.
D—1743 Redetermination Indicates a Change of Address
Revision 15-4; Effective October 1, 2015
CHIP
If the redetermination form indicates a household moved and now has different health plan options, a Health Plan Change (HPC) letter is mailed to the household and includes:
a health plan change form;
a comparison chart that includes a value-added service matrix;
the health plan change/redetermination instruction letter; and
a self-addressed stamped envelope.
The health plan change/redetermination instruction letter informs the household they may change health plans:
by phone,
in writing using the Enrollment/Transfer form submitted by fax or mailed to:
HHSC PO Box 149023 Austin, TX 78714-9023
by IVR, or
online using YourTexasBenefits.com .
The Enrollment Broker must receive the completed health plan change form before enrolling a household in a new health plan. A household that moves to an area of choice remains with its current health plan until the Enrollment Broker receives the completed health plan change form or the health plan transfer is completed by phone. If the household reports the change of address online, the household is also able to make a health plan change online. If the household does not return its completed health plan change form by the cutoff of its last month of certification, the household is enrolled in the next available health plan using a default process. The household is sent the ECN informing the household of the new health plan selection.
The child is enrolled in the designated health plan during the next certification period.