MEMORANDUM

DISCUSSION:

This memorandum is to introduce new policy on determining private affordable health care coverage on CHIP cases.

Individuals will no longer be required to provide private insurance quotes.  FSD will compare CHIP premium amounts to insurance premium amounts on the Federally-Facilitated Marketplace (FFM) to determine affordability based on size of the household and the region of the state they live in.

FSD will determine if private insurance is affordable by using the CHIP Affordability Calculator.  The process is outlined in policy and instruction on the CHIP Affordability Calculator.

NOTE:  Individuals will still be required to provide employer sponsored insurance quotes.

Insurance can be purchased from the FFM only during the open enrollment period, the dates of which can change each year.  In some situations an individual may qualify for a special open enrollment period with the FFM.  While the qualifications for the special enrollment period are available at healthcare.gov, the FSD does not determine the special open enrollment period, and should not make determinations that a participant qualifies for one.   

NOTE:  Undocumented aliens are not insurable.  Do not ask for private insurance quotes for non-citizens.

Private insurance, purchased separately from the FFM, is available during open and closed enrollment periods.

 

NECESSARY ACTION:

• Review this memorandum with appropriate staff.

PL/ks