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CHIPRA


CHIPRA, the Children’s Health Insurance Program Reauthorization Act, was signed into law on Feb. 4, 2009. The CHIPRA program provides the ability to individual States to subsidize premiums for employer-provided group health coverage for eligible children.

 

Determining Eligibility

HIPAA special enrollment rights require group health plans to permit an employee who is eligible, but not enrolled, for coverage under the plan to enroll if either of the following conditions are met:

 

1.  Employee/dependent covered under Medicaid or CHIP has coverage terminated as a result of loss of eligibility, and the employee requests coverage under the group health plan within 60 days after such termination; or

 

2.  Employee/dependent becomes eligible for Medicaid or CHIP assistance if the employee requests coverage within 60 days after the eligibility determination date.

 

Notice Requirement

Plan sponsors must provide a notification to their employees, each year, notifying them that the employer maintains a group health plan in a state that provides premium assistance under Medicaid, or CHIP. The notification must be provided to each employee (regardless of enrollment status) giving them notice of the potential opportunities for premium assistance for health coverage of the employee or their dependents currently available in the state (in which the employee resides).

 

The notice is not required to be sent to individuals who reside in States where there is no premium assistance, however administratively this could cause a burden to the employer. If an employee moves States during their employment or a State begins to offer premium assistance, the employer will need to track those individuals to now receive the notice. The employer may choose to send the notice to every employee regardless of State of residence.

 

The notice may be sent to each employee with regular informational distributions or the notice may be provided electronically, provided the DOL safe harbor for electronic disclosure is satisfied.

 

Meritain's enrollment form contains this Notice. Plans using the Meritain form will meet this requirement, but if they choose to use a customized enrollment form that does not include this information, the group will need to provide a separate notice.

 

Penalties

There can be penalties of up to $112 a day for failure to comply with the notice requirements.

 

This content is being provided as an informational tool. It is believed to be accurate at the time of posting and is subject to change. It is recommended that plans consult with their own experts or counsel to review all applicable federal and state legal requirements that may apply to their group health plan. By providing this information, Meritain Health is not exercising discretionary authority or assuming a plan fiduciary role, nor is Meritain Health providing legal advice.