CHIP ARKANSAS

Eligibility

CHIP Eligibility Requirements (PDF)

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  1. Federally Eligible Individuals

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

    1. Be a resident of Arkansas;
    2. Have, as of the date on which CHIP receives your application*, an aggregate of 18 months of Creditable Coverage without a break in coverage of 63 days or more;
    3. 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);
    4. 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);
    5. not have had your most recent creditable coverage terminated based upon a factor related to nonpayment of premiums or fraud;
    6. have elected and exhausted any continuation of coverage option under COBRA or a similar state law continuation provision;
    7. not currently have other health insurance coverage;
  2. Resident Eligible Persons

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

      1. 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

    1. 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 CHIP receives  your application* and was not terminated for reasons of fraud; and
    2. 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);
    3. 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;
    4. not have previously terminated CHIP coverage in the twelve (12) months prior to the date the individual applies for CHIP coverage;
    5. not have previously received CHIP benefits equaling $1,000,000 or more;
    6. not be a resident of a public institution; and
    7. 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.
  3. Persons Eligible for the Health Coverage Tax Credit (“HCTC”) and Qualifying Family Members

    1. HCTC Qualified Eligible Person and His or Her Qualifying Spouse or DependentsIndividuals 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. These persons must meet the eligibility criteria described below:
      1. HCTC Qualified Eligible PersonIn order to be eligible for coverage under the CHIP Policy as a HCTC Qualified Eligible Person, a person:
        1. Must have, as of the date CHIP receives your application* for 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;
        2. must be legally domiciled in Arkansas;
        3. 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);
        4. must not be incarcerated by a federal state or local authority;
        5. must not be eligible for coverage for, or enrolled in, Part A or B of Medicare;
        6. 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
      2. HCTC Qualified Eligible Family MemberAn 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.
    2. HCTC Standard Eligible Person and His or her Qualifying Spouse or DependentsIf 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:
      1. HCTC Standard Eligible PersonIn 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; or
          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 and
        6. must not be enrolled in or eligible foray 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.
      2. HCTC Standard Eligible Family MemberAn 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.
  4. Special Rules for Newborn Children of CHIP policyholders.

    A CHIP policyholder may enroll his or her newborn child who is an Arkansas resident in a separate CHIP policy if the policyholder applies to CHIP within 31 days after the child’s birth. If the application is timely, the child will not be subject to preexisting condition limitations. Contact CHIP for more information.

*You may fax or email your application to CHIP to make sure that you meet this deadline. Please see enrollment form for more information.