Page 1795

West Virginia Income Maintenance Manual Chapter 22

West Virginia Income Maintenance Manual Page 9 Chapter 22 West Virginia Children’s Health Insurance Program (WVCHIP)

Copies of client Explanation of Benefits (EOB) can be obtained from the Department’s fiscal agent. The fiscal agent can also provide information about the status of medical claims or problems related to medical payments. In compliance with the requirements of the Patient Protection and Affordable Care Act, Public Health Service Act, effective July 1, 2011, WVCHIP clients do not have an annual and/or lifetime benefit maximum. 22.2.6.F Agency Time Limit The policy in Section 1.7.4 regarding Children Under Age 19 applies to WVCHIP. A child must first be determined ineligible for MAGI Medicaid before being eligible for WVCHIP.

EXCEPTION: Children who are members of a federally recognized American Indian or Native Alaskan tribe are exempt from premiums, deductibles, and co-payments. American Indian/Alaska Native (AI/AN) means: 1) a member of a Federally recognized Indian tribe, band or group; 2) an Eskimo or Aleut or other Alaska Native enrolled by the Secretary of the Interior pursuant to the Alaska Native Claims Settlement Act, 43 U.S.C. 1601 et. Seq.; or 3) a person who is considered by the Secretary of the Interior to be an Indian for any purpose. The client can claim this exemption by calling the WVCHIP Help Line at 1 (877) 982-2447 to declare his tribal designation and confirm that it is listed as a federally recognized tribe.

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Page 1795

Official source

West Virginia Income Maintenance Manual Chapter 22

West Virginia Income Maintenance Manual Page 9 Chapter 22 West Virginia Children’s Health Insurance Program (WVCHIP)

Copies of client Explanation of Benefits (EOB) can be obtained from the Department’s fiscal agent. The fiscal agent can also provide information about the status of medical claims or problems related to medical payments. In compliance with the requirements of the Patient Protection and Affordable Care Act, Public Health Service Act, effective July 1, 2011, WVCHIP clients do not have an annual and/or lifetime benefit maximum. 22.2.6.F Agency Time Limit The policy in Section 1.7.4 regarding Children Under Age 19 applies to WVCHIP. A child must first be determined ineligible for MAGI Medicaid before being eligible for WVCHIP.

EXCEPTION: Children who are members of a federally recognized American Indian or Native Alaskan tribe are exempt from premiums, deductibles, and co-payments. American Indian/Alaska Native (AI/AN) means: 1) a member of a Federally recognized Indian tribe, band or group; 2) an Eskimo or Aleut or other Alaska Native enrolled by the Secretary of the Interior pursuant to the Alaska Native Claims Settlement Act, 43 U.S.C. 1601 et. Seq.; or 3) a person who is considered by the Secretary of the Interior to be an Indian for any purpose. The client can claim this exemption by calling the WVCHIP Help Line at 1 (877) 982-2447 to declare his tribal designation and confirm that it is listed as a federally recognized tribe.