601-3 Cost Sharing Exemptions

Effective: June 1, 2012

Previous Policy

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In certain instances, families may be exempt from paying any co-payments, and in some cases any quarterly premiums. The health plan identification card shows providers when clients are exempt from paying any co-payments and deductibles.

1. American Indian/ Alaska Native Children are not required to pay co-payments or quarterly premiums.  (The application forms have an optional field for CHIP applicants to declare their race.)

1. Applicants:  Allow CHIP coverage with the cost sharing exemption when an individual declares to be an American Indian/Alaska Native, and there is no evidence that contradicts their claim.

1.    Give the client reasonable time to provide documentation of their status.  "Reasonable time" is at least 30 days.  A client may request more time if needed.

2.    If the client has been given reasonable time and does not provide the documentation or proof that they are working on obtaining it, remove the exemption with proper 10 day notice.

2. Enrollees:  Request proof of American Indian/Alaska Native status of CHIP enrollees at their first review after July 1, 2010 if their status was self-declared at application and tribal verification has not yet been provided.  

• If the client fails to provide the verification at renewal or if the verification shows that they are not an American Indian or Alaska Native, stop the exemption with proper 10 day notice.

3. If verification of their American Indian/Alaska Native status is received at any time, continue or start the cost sharing exemption.

1. Any past cost sharing monies paid during the 12 months prior to the month of verification will be refunded to the client.

2. No cost sharing should be collected once verification is received.

4. Acceptable Verification of American Indian/Alaska Native Status can be met with ONE of the following.

1. Tribal Identification/Enrollment Card or Number.

2. Certificate of Degree of Indian or Alaska Native Blood (CDIB) signed by the Bureau of Indian Affairs (BIA).

3. Tribal court documents.

4. Indian Health Services (IHS) Face Sheet.  An Indian Health Services (IHS) face sheet is a medical record certified by IHS as being from their original records.

• The face sheet must contain identifying information about the client. IE, name, date of birth.

• The face sheet must contain the tribal association. Tribal membership verification must be for the CHIP child and the tribe must be recognized by the Federal government.  Click on the following link for a list of federally recognized tribes:  http://www.indians.org/Resource/FedTribes99/fedtribes99.html

2. Zero Countable Income Families are not required to pay co-payments or quarterly premiums when they have zero countable income. (see 601-2)  

1. The computer system does not set this up automatically.

2. Eligibility staff must inform the CHIP Administration Office, currently email Kimra Goble at kimragoble@utah.gov.

The email must include:

• Case number and case name

• Name and ID number of each child exempt from co-payments and deductions

• CHIP certification start date and end date

(Please contact Kimra Goble at 801-538-6728 with any additional questions.)