The State Children’s Health Insurance Program (SCHIP) is a state program that provides health insurance to low-income families with children under the age of 19 who are not eligible for Medicaid and are uninsured.
- To be eligible for SCHIP, your child must meet certain qualifications. Your household income must be at or below 250% of the federal poverty level (FPL). For a family of 3, this works out to an annual income of about $42,920 or about $3,577 per month. In addition, your child cannot be eligible for Medicaid or have other “creditable health coverage”. Creditable health coverage means coverage under a group health plan or other health insurance that provides access to physician, hospital, radiology and laboratory services.
- If your child drops employer sponsored group health plan to enroll in SCHIP s/he may have wait 4 months before becoming eligible for coverage. Generally, if one drops employer sponsored health care there is a 4-month waiting period to be eligible for SCHIP. However, there are many exceptions to this rule. For example, if your child has a condition that, without treatment, would be life threatening or cause serious or loss of function, s/he may be eligible to apply for SCHIP immediately. Before you drop any health insurance for SCHIP, it is important to check in advance to see if and when your child will be eligible for SCHIP.
- SCHIP does not impose a pre-existing condition exclusion period and your child cannot be excluded because of his or her health. SCHIP coverage begins the first day of the month in which the application was submitted. So, if you apply on March 21 and your child is found eligible, s/he will be covered as of March 1. Continued eligibility for SCHIP will be reassessed every 6 months.
- SCHIP covered benefits are comprehensive.. The program’s benefits are the same as those provided by the Medicaid program for children. SCHIP provides doctor visits, hospital care, prescriptions, mental health services, preventative well-child exams, immunizations, dental and eye exams, among other services.
- You will have to pay a small monthly premium. As of January 1, 2008 the monthly premium costs of SCHIP is $15 per child per month, with a $45 family maximum per month.
- If your income goes down and you cannot pay premiums, your children may be eligible for Medicaid, which requires no premiums. For more information on Medicaid eligibility call the Washington State Department of Social and Health Services at (800) 562-3022 or visit them online at http://www1.dshs.wa.gov
- For more information on the Children’s Health Insurance Program, call (877) KIDS-NOW or (877) 543-7669) or visit them online at http://fortress.wa.gov/dshs/maa/chip/.