Arkansas Comprehensive Health Insurance Pool

ARKANSAS COMPREHENSIVE
HEALTH INSURANCE POOL
P.O. Box 419
Little Rock, AR 72203
Phone: 1-800-285-6477

Eligibility

I. Federally Eligible Individuals

To enroll in CHIP as a "Federally Eligible Individual," you must:

be a resident of Arkansas;
have, as of the date on which you complete your CHIP application, an aggregate of 18 months of Creditable Coverage without a break in coverage of 63 days or more;
have been covered most recently by Creditable Coverage offered through a Group Health Plan, a Governmental Plan, or a Church Plan (or Health Insurance Coverage offered in connection with any such plans);
not be currently covered by, or eligible for, coverage under:
1. a Group Health Plan;
2. Part A or Part B of Medicare; or
3. the Arkansas Medical Assistance Program (Medicaid or ARKids);
not have had your most recent creditable coverage terminated based upon a factor related to nonpayment of premiums or fraud;
have elected and exhausted any continuation of coverage option under COBRA or a similar state law continuation provision;
not currently have other health insurance coverage;

II. Resident Eligible Persons

To enroll in CHIP as a "Resident Eligible Person," you must:

have been a resident of Arkansas for at least 90 days and present evidence to the Administrator of:
1. a notice of rejection or refusal by an insurer to issue substantially similar individual health insurance coverage by reason of the existence or history of a medical condition; or
2. a refusal by an insurer to issue individual health insurance coverage except at a rate substantially in excess of (at least 50% greater than) the applicable premium rate under a comparable CHIP Policy;
or
have been a resident of Arkansas for at least 30 days and present evidence to the Administrator that you were covered under a Qualified High Risk Pool of another state, if such coverage ended no more than 63 days before you complete your CHIP application and was not terminated for reasons of fraud;

and
Not be enrolled in or eligible for coverage through a Group Health Plan, Part A or B of Medicare or the Arkansas Medical Assistance Program (Medicaid and ARKids);
Not be enrolled in any other Health Insurance Coverage, except that if you have provided the administrator evidence required by either paragraph 1, 2 or 3, above, and meet the requirements of paragraphs 5-8, below, you may maintain any existing health insurance coverage while you are satisfying the pre-existing condition waiting period under the CHIP Policy;
not have previously terminated CHIP coverage in the twelve (12) months prior to the date the individual applies for CHIP coverage;
not have previously received CHIP benefits equaling $1,000,000 or more;
not be a resident of a public institution; and
not have premium paid on the individual's behalf under any governmental sponsored program or by any government agency or health care Provider, except premiums paid on behalf of an otherwise qualifying full time employee, or dependent of such employee, of a government agency or health care provider.

III. Special Rules for Newborn Children of Federally Eligibles and Resident Eligibles

CHIP does not offer family plans and does not offer coverage based on a person's status as a dependent of a Federally Eligible Individual or a Resident Eligible Person, except as provided in this section. If a person is insured under CHIP as a Federally Eligible Individual or a Resident Eligible Person at the time a newborn child is born to the person, the child will be issued a CHIP Policy providing coverage from the date of birth if:

the Insured Person submits an application on behalf of his/her newborn child within thirty-one (31) days of the date of the child's birth;
the premium for the newborn's CHIP Policy is paid when the policy is issued;
the newborn child is not eligible for any other health benefits coverage whether insured, self insured or a governmental program; and
the newborn child is a resident of the State of Arkansas.

IV. Persons Eligible for the Health Coverage Tax Credit and Qualifying Family Members

A HCTC Qualified Eligible Person and His or Her Qualifying Spouse or Dependents. Individuals eligible for the HCTC who have at least three (3) months of Creditable Coverage without a break in coverage of 63 days or more, and the spouse or Dependents of those individuals, may be eligible for CHIP coverage without being subject to preexisting condition exclusions (see pages 10-11 of this outline of coverage). These persons must meet the eligibility criteria described below:

HCTC Qualified Eligible Person. In order to be eligible for coverage under the CHIP Policy as a HCTC Qualified Eligible Person, a person:

MUST HAVE, AS OF THE DATE THE INDIVIDUAL COMPLETES AND SUBMITS AN APPLICATION FOR CHIP COVERAGE, AN AGGREGATE OF AT LEAST THREE (3) MONTHS OF CREDITABLE COVERAGE WITHOUT A BREAK IN SUCH COVERAGE OF SIXTY-THREE (63) DAYS OR MORE;
1. must be legally domiciled in Arkansas;
2. must present to CHIP a letter or other written notice from the Health Coverage Tax Credit Program that the individual is or may be eligible for the Health Coverage Tax Credit (HCTC);
3. must not be incarcerated by a federal state or local authority;
4. must not be eligible for coverage for, or enrolled in, Part A or B of Medicare;
5. must not be enrolled in:
  1. the Arkansas Medical Assistance Program (Medicaid or ARKids);
  2. a federal employee health plan;
  3. a U.S. military health plan (TRICARE/CHAMPUS);
  4. a health plan provided through the person's, or the person's spouse's, current or former employer, if the employer contributes more than 50% of the family's cost of coverage; or
  5. a plan provided through the person's, or the person's spouse's, current or former employer, if the employer provides the coverage in lieu of cash or other benefits under a cafeteria plan and
6. HCTC Qualified Eligible Family Member. An individual may be enrolled for coverage as a HCTC Qualified Eligible Family Member if:
  1. the individual is the spouse or Dependent for federal income tax purposes of a HCTC Qualified Eligible Person;
  2. the individual is:
    1. not eligible for coverage for, or enrolled in, Part A or B of Medicare;
    2. not enrolled in:
      1. the Arkansas Medical Assistance Program (Medicaid or ARKids);
      2. a federal employee health plan;
      3. a U.S. military health plan (TRICARE/CHAMPUS);
      4. a health plan provided through the person's, or the person's spouse's, current or former employer, , if the employer contributes more than 50% of the family's cost of coverage; or
      5. a plan provided through the person's, or the person's spouse's, current or former employer, if the employer provides the coverage in lieu of cash or other benefits under a cafeteria plan; and
  3. the HCTC Qualified Eligible Person applies for coverage for the spouse or Dependent at the same time he or she applies for coverage, or within 31 days after the spouse or Dependent Family Member first qualifies for coverage under subsections (1) and (2), above.

B. HCTC Standard Eligible Person and His or her Qualifying Spouse or Dependents. If a person eligible for HCTC does not have the three months of Creditable Coverage described above, the person and his or her spouse and Dependents still may qualify for CHIP coverage if they meet the following criteria:

HCTC Standard Eligible Person. In order to be eligible for coverage under the Policy as a HCTC Standard Eligible Person, a person:
1. must be legally domiciled in Arkansas;
2. must present to CHIP a letter or other written notice from the Health Coverage Tax Credit Program that the individual is or may be eligible for the Health Coverage Tax Credit (HCTC);
3. must not be incarcerated by a federal state or local authority;
4. must not be eligible for coverage for, or enrolled in, Part A or B of Medicare or the Arkansas Medical Assistance Plan (Medicaid and ARKids First);
5. must not be enrolled in:
  1. a federal employee health plan;
  2. a U.S. military health plan (TRICARE/CHAMPUS);
  3. a health plan provided through the person's, or the person's spouse's, current or former employer, if the employer contributes more than 50% of the family's cost of coverage;
  4. a plan provided through the person's, or the person's spouse's, current or former employer, if the employer provides the coverage in lieu of cash or other benefits under a cafeteria plan; or
6. must not be enrolled in or eligible for any other Health Insurance Coverage, including the coverage described in paragraph (5), above, if the coverage is substantially similar to or more comprehensive than the CHIP policy, except that:
  1. a person may maintain other coverage for the period of time such person is satisfying any pre-existing condition waiting period under the Policy; and
  2. a person may maintain coverage under this Policy for the period of time such person is satisfying a pre-existing condition waiting period under another Health Insurance Coverage, Group Health Plan, or other coverage intended to replace the Policy;
7. must not:
  1. have previously terminated CHIP coverage unless twelve (12) months have elapsed since the termination of the CHIP coverage;
  2. have received benefits under a prior CHIP policy of $1,000,000 or more in Covered Expenses or benefits of any kind;
  3. be a resident of a public institution;
  4. fail to pay the required premium under the CHIP Policy; or
  5. have premium paid on the person's behalf under any governmental sponsored program or by any government agency or health care Provider, except premiums paid:
    1. as advance payment on the Health Coverage Tax Credit; or
    2. on behalf of an otherwise qualifying full time employee, or Dependent of such employee, of a government agency or health care provider;
8. MUST PROVIDE EVIDENCE TO CHIP'S ADMINISTRATOR:
  1. of a notice of rejection or refusal by an insurer to issue substantially similar individual Health Insurance Coverage by reason of the existence or history of a medical condition (a rejection or refusal by a Group Health Plan or by an insurer offering only Excess or Stop Loss Coverage, or contracts, agreements, or other arrangements for reinsurance coverage with respect to the Applicant shall not be sufficient evidence under this subsection) ;
  2. of a refusal by an insurer to issue individual Health Insurance Coverage except at a rate which CHIP determines is substantially in excess of the applicable premium rate under this Policy; or
  3. that the Applicant was covered under a Qualified High Risk Pool of another state, provided that the coverage terminated no more than 63 days prior to the date CHIP received the Applicant's completed application, and the other state's Qualified High Risk Pool did not terminate the Applicant's coverage due to fraud.
HCTC Standard Eligible Family Member. An individual may be enrolled for coverage as a HCTC Standard Eligible Family Member if:
1. the individual is the spouse or Dependent for federal income tax purposes of a HCTC Standard Eligible Person;
2. the individual is:
  1. not eligible for coverage for, or enrolled in, Part A or B of Medicare;
  2. not enrolled in:
    1. the Arkansas Medical Assistance Program (Medicaid or ARKids);
    2. a federal employee health plan;
    3. a U.S. military health plan (TRICARE/CHAMPUS);
    4. a health plan provided through the person's, or the person's spouse's, current or former employer, if the employer contributes more than 50% of the family's cost of coverage; or
    5. a plan provided through the person's, or the person's spouse's, current or former employer, if the employer provides the coverage in lieu of cash or other benefits under a cafeteria plan; and
3. the HCTC Standard Eligible Person applies for coverage for the spouse or Dependent at the same time he or she applies for coverage, or within 31 days after the spouse or Dependent Family Member first qualifies for coverage under sections (1) and (2), above.

V. Special Rules for Newborn Children of HCTC Eligibles.

The following rules apply to newborn natural children of Insured Persons:

Newborn child of a HCTC Qualified Eligible Person or HCTC Standard Eligible Person. The newborn child will be issued a CHIP Policy providing coverage from the date of birth if:
1. the HCTC Standard Eligible Person or HCTC Qualified Eligible Person submits an application on behalf of his/her Newborn Child within thirty-one (31) days of the date of the child's birth;
2. the premium for the Newborn's CHIP Policy is paid when the Policy is issued; and
3. the newborn child meets the criteria for a HCTC Qualified Eligible Family Member or a HCTC Standard Eligible Family Member (see sections I.B and II.B, above).
Newborn child of a HCTC Qualified Eligible Family Member or a HCTC Standard Eligible Family Member. The newborn child of any other Insured Person under the Policy will be issued a CHIP Policy providing coverage from the date of birth if:
1. the Insured Person submits an application on behalf of his/her newborn child within thirty-one (31) days of the date of the child's birth;
2. the premium for the newborn's CHIP Policy is paid when the Policy is issued;
3. the newborn child is not eligible for any other health benefits coverage whether insured, self insured or a governmental program; and
4. the newborn child is a resident of the State of Arkansas.