• CHIP coverage is offered through a managed care plan. After you satisfy your annual deductible, the plan will pay 80% of covered charges when you get care from a hospital, doctor, or other provider in the CHIP network. When your cost sharing reaches the “out-of-pocket” limit, CHIP will pay 100% of covered charges. If you get care from a provider outside the network, CHIP will pay 60% of covered services, after you satisfy your annual deductible. Your 40% share of cost for out-of-network care will not count toward the “out-of-pocket” limit.
• CHIP offers 3 deductible options. Your annual deductible can be $1,000, $5,000, or $10,000, depending on which policy you choose.
• Covered benefits include hospital and nursing facility care, physician care, and prescription drugs. There are special limits on treatment for mental disorders and chemical dependency. Routine maternity coverage can be purchased for an additional premium. There is a lifetime limit of $1 million on all covered benefits.

What about coverage for my pre-existing condition?

• If you are HIPAA eligible, no pre-existing condition exclusion will be imposed when you enroll in CHIP.
• If you are not HIPAA eligible, you may have a 6-month pre-existing condition exclusion period when you first enroll in CHIP. When you enroll, CHIP will look back 6 months to see if you had a condition for which you actually received - or for which most people would have sought - a diagnosis, medical advice, or treatment. This is called the prudent person rule. Pregnancy and genetic information can be considered pre-existing conditions.
• If you are not HIPAA eligible, CHIP may waive your pre-existing condition exclusion period if you meet certain conditions. You must have had at least 6 months of prior group coverage that was involuntarily terminated, and you must have satisfied a similar pre-existing condition exclusion under your prior coverage. You must apply for CHIP not later than 30 days following the involuntary termination, and you must be ineligible for continuation coverage. CHIP will also require that you pay a 10% surcharge on your premiums for 5 years.
• If you are eligible for the HCTC, you may be able to avoid the application of a pre-existing condition exclusion period. If you are HCTC eligible and maintained prior creditable coverage for a total period of three months as of the date that you applied for coverage, and there was no break in coverage greater than 63 days, insurers may not impose a pre-existing condition exclusion period against you.

What can I be charged for CHIP coverage?

• CHIP premiums vary depending on your age, deductible, whether you elect maternity coverage, and whether you receive a waiver of your pre-existing condition exclusion period.
• For example, as of July 1, 2006, the monthly premium for a 24-year-old man can range from $90 to $165, depending on the deductible he chooses and whether he pays the 10% pre-existing condition surcharge. By contrast, the monthly premium for a 64-year-old man can range from $482 to $882, depending on the deductible selected and whether the pre-existing condition surcharge is paid. Optional maternity coverage can add up to about $200 to your monthly premiums, depending on your age.

Contact CHIP for more information about plan and premium options at (800) 285-6477 or visit http://www.chiparkansas.org/.

How long does CHIP coverage last?

• CHIP policies are renewable as long as you pay your premiums, continue to reside in Arkansas, and meet other eligibility requirements.