Your Child’s Eligibility, Coverage and Payments

Eligibility   |   Coverage   |   Payment   |   Termination of Coverage   |   Impartial Eligibility Review

Payment

Who Pays a Premium?
Depending on your family income, your child may be eligible for either free or low cost health insurance.

• If your child is eligible for Free CHIP, you will not be required to pay a monthly premium.
• If your child is eligible for Low Cost CHIP, you will be required to pay a monthly premium which is a portion of the actual cost to insure your child. (The balance of the cost is paid for by state funds and the Independence Blue Cross & Highmark Blue Shield Caring Foundation.)

	NOTE: You will be required to pay for the first month’s coverage up front for Low Cost CHIP. After that time, you will be billed monthly by Keystone.

What Happens if a Premium is Paid Late?
If you fail to pay your Low Cost CHIP premium within 30 days of the due date, your child’s coverage will be terminated at the end of the last month for which you did pay the premium. You will be responsible for any medical or dental costs incurred after that date.

If coverage is terminated for Low Cost CHIP because you fail to pay the premium on time, you will have to go through the application process from the beginning in order to have your child’s coverage reinstated.

Termination of Coverage

The Caring Foundation may cancel your child’s coverage under the following conditions:

1. If you commit willful misrepresentation or fraud in applying for or obtaining coverage for your child from the Caring Foundation (subject to your rights under the complaint procedure);
2. If you misuse either of your child’s ID cards, or allow someone other than your enrolled child to use the ID Cards to receive care or benefits;
3. If your child ceases to meet eligibility requirements;
4. If you fail to respond to the renewal request or return incomplete information with the renewal (More information available); or
5. If you fail to pay your low cost premium within 30 days of the due date.

Inpatient Provision
If your child is receiving inpatient care in a hospital or skilled nursing facility on the day CHIP coverage is terminated, except for termination due to fraud or material misrepresentation, the benefits shall be provided until the earliest of:

1. the expiration of such benefits according to the limitations included with this handbook;
2. determination of the primary care physician and Keystone that inpatient care is no longer medically necessary; or
3. your child’s discharge from the facility.

	NOTE: The Caring Foundation will not terminate your child’s coverage because of his or her health status or need for medically necessary covered services, or because you exercised your rights under the complaint and grievance process.