New Requirements for State Children’s Health Insurance Program
As you know, the Children’s Health Insurance Program Reauthorization Act of 2009 was signed into law on February 4, 2009, and reauthorizes the State Children’s Health Insurance Program (SCHIP) for four and a half more years.
New 60-day enrollment opportunities
The legislation provided for two new special enrollment opportunities to elect coverage under group health plans. A special enrollment period of 60 days will be allowed in the following additional circumstances:
1) If a member or his or her eligible dependent’s coverage under Medicaid or the SCHIP is terminated due to loss of eligibility; or
2) If a member or his or her eligible dependent becomes eligible for premium assistance under a state Medicaid or SCHIP plan.
The special enrollment rights became effective for plan years beginning on or after April 1, 2009. Insurers and Administrators of self-funded plans, began to include these new rights in benefit plan materials upon group renewal beginning as early as July 1, 2009, depending on the state.
Notice requirements
In conjunction with the special enrollment rights, the law also imposed two new disclosure requirements:
1) On February 4, 2010, the secretaries of Labor and Health and Human Services issued the model employer notice, designed to ensure that employees are aware of possible premium assistance opportunities that may be available to them. Employers are required to provide these notices to all employees by the date that is the later of 1. The first day of the plan year after February 4, 2010, or 2. May 1, 2010. The model notice is available at http://www.dol.gov/ebsa/chipmodelnotice.doc or click MODEL NOTICE
2) A plan administrators notice – designed to ensure that the states, upon request, have adequate information to properly coordinate coverage for individuals who are eligible for both state assistance and employer-sponsored coverage – will be issued by August 4, 2010. The secretaries of Labor and Health and Human Services will publish a model coordination of coverage disclosure form that plan administrators must use to provide the required information to the state.
Each state will develop its own guidelines as to when or if it is cost effective to provide premium assistance for people eligible for Medicaid or SCHIP to buy into their employers’ health plans. The subsidy may be provided as a reimbursement to the employee or as a direct payment to the employer (unless the employer opts out of receiving direct payments).
