THE CHIP PLANS

The Traditional Plan is a Preferred Provider Organization (PPO) plan available only to eligible persons who qualify for coverage because they have been denied major medical coverage due to their health by private insurers and are not eligible for Medicare. To receive maximum benefits under the plan, a designated PPO provider must be used. The Traditional Plan has five standard deductible options to choose from: $500, $1,000, $1,500, $2,500 and $5,000.

The Traditional Plan also has deductible options available to persons who qualify for coverage under Section 7 and who are interested in purchasing a plan that qualifies as a High Deductible Health Plan (HDHP) that can be used in conjunction with a federally approved Health Savings Account (HSA). All covered services and supplies, including prescription drugs, are subject to a deductible which must be satisfied before the plan will pay any benefits. The Traditional Plan has three HDHP deductible options to choose from: $1,300, $2,000 and $5,200. These Traditional Plan HDHD deductible options are subject to change, based on the federal requirements for minimum and maximum deductibles for HDHP Plans.

The Medicare Plan is the only plan available to eligible persons who are enrolled in both Parts A and B of Medicare due to disability or end-stage renal disease since they are ineligible for all other CHIP benefit plans. The Medicare Plan does not provide coverage for prescription drugs (except in very limited circumstances). The Medicare Plan is not available or renewable beyond the date a person would have been eligible for Medicare due to age. Benefits under the Medicare Plan are always secondary to Medicare, and are reduced by any amounts payable under Medicare Parts A and B. This is referred to as a "carve-out" plan that is secondary to Medicare (Medicare will pay benefits first, and will be the "primary" coverage). The Medicare Plan has five deductible options to choose from: $500, $1,000, $1,500, $2,500 and $5,000.

Federally eligible individuals in the individual market are those who, at the time they seek individual coverage, satisfy all of the following criteria:

1. they must have accrued a total of 18 or more months of prior creditable coverage; they have no more than a 90 day break between periods of creditable coverage;
2. their most recent creditable coverage must have been provided under a group health plan, governmental plan or church plan;
3. they must not be eligible for group health coverage, Medicare or Medicaid, and must not have any other health insurance coverage;
4. their most recent coverage must not have been terminated due to nonpayment of premium or fraud; and,
5. if offered continuation of coverage under federal COBRA requirements or state continuation laws, they must have elected and exhausted such continuation coverage.

The HIPAA Plan is a Preferred Provider Organization (PPO) plan available only to federally eligible individuals who qualify for coverage because they have had prior creditable coverage and meet the other HIPAA requirements. To received maximum benefits under the plan, a designated PPO provider must be used. The HIPAA Plan has five deductible options to choose from: $500, $1,000, $1,500, $2,500 and $5,000.

The HIPAA-HCTC Plans are Preferred Provider Organization (PPO) plans available only to federally eligible individuals who qualify for the HCTC. There are two ways to qualify for the HIPAA-HCTC Plans: persons can qualify through the PBGC or through the TAA. To receive maximum benefits under the plan, a designated PPO provider must be used. The HIPAA Plan has five deductible options to choose from: $500, $1,000, $1,500, $2,500 and $5,000.

Both the HIPAA and the HIPAA-HCTC Plans also have deductible options available to persons who qualify for coverage and who are interested in purchasing a plan that qualifies as High Deductible Health Plan (HDHP) that can be used in conjunction with a federally approved Health Savings Account (HSA). All covered services and supplies, including prescription drugs, are subject to a deductible which must be satisfied before the plan will pay any benefits. The HIPAA-HDHP Plan, and the HIPAA-HCTC Plans each have three HDHP deductible options: $1,300, $2,000 and $5,200. The deductible options for each of these HIPAA Plans that qualify as HDHPs are subject to change, based on the federal requirements for minimum and maximum deductibles for HDHP plans.

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A person having one of these medical conditions is presumed to be uninsurable, and is not required to receive a rejection letter for health reasons from an insurance company before applying for CHIP as a non-federally eligible person under Section 7 of the CHIP Act. In such cases, applicants for CHIP may instead submit a letter from their attending physician identifying one of these medical conditions for which they are being treated.

Medical conditions that do not require a notice of rejection or refusal to issue individual health insurance for health reasons from an insurer:

Enrollment in Medicare and the Traditional programs is currently capped at 5,950 participants.

If the program is ever at capacity when application is made, applicants who qualify may be placed on a waiting list as of the date their application is complete and all of the eligibility requirements are met. As additional enrollment opportunities become available, applicants will then be contacted in the order in which they appear on the waiting list. Therefore, anyone seeking coverage under either the Medicare or Traditional Plan should apply as soon as possible.

At present, the program is not at capacity.