Example: If you have 4 members in your household who you're responsible for, you're income must be equal to or less than $3,400 per month, before taxes.
Does my income determine if I can receive premium assistance?
Yes. Your qualification for premium assistance is based on several criteria, one of which is family income. Please refer to the chart provided. Look at the number of people you are financially responsible for (your family size) and your total household income before taxes. You must have an income less than or equal to the amounts in this chart.
Can my family members receive premium assistance?
If you qualify, your spouse and your minor children do as well. This program offers premium assistance for you, your spouse, and any minor child you choose to enroll. Each child under the age of 19 that you elect to enroll is qualified for up to $100/month in premium assistance, with a maximum assistance of up to $300/month for all of your children.
What if I currently have health insurance?
You can not receive premium assistance if you already have health insurance. This is a program to assist individuals who are uninsured.
Can I use this as my secondary insurance?
No, this is a program to assist individuals who are uninsured.
When will I know if I qualify for premium assistance?
You will be notified within 60 days from the date your employer submits the required paperwork to the insurance representative. The paperwork includes your application for insurance as well as your application for premium assistance.
If my child or children are in the Access to Health Insurance program, can they switch to coverage under the Idaho Health Plan (CHIP/Medicaid)?
Yes, your child may leave (opt-out) the Access to Health Insurance program to receive health insurance coverage through the Idaho Health Plan (CHIP/Medicaid) at any point. Coverage can begin the first day of the following month. If you want to switch to the Idaho Health Plan, you must call the Idaho Falls Processing Center at 1 (866) 326-2485 before the 15th of the month in order for your child to be enrolled for the next month.
Are my child's health insurance benefits different under premium assistance than under the Idaho Health Plan (Medicaid/CHIP)?
The benefits (health care services) that your private health insurance provides may not be the same as those offered by the Idaho Health Plan (Medicaid/CHIP). There may be fewer benefits or services covered. The benefits covered by the Idaho Health Plan are described in a booklet called, "Idaho Health Plan Coverage". You can have this booklet sent to you by calling the Idaho CareLine at 2-1-1 or you can download or view one at www.medicaid.idaho.gov. your employer (or insurance agent) can provide you with a summary plan description that you can compare to the services provided under the Idaho Health Plan in order to determine which coverage best meets your health care needs.
Are my out-of-pocket costs for helath care services different for children when I choose premium assistance for health insurance benefits through my employer's health plan rather than under the Idaho Health Plan (CHIP)?
Sometimes the out-of-pocket costs (such as deductibles and co-payments) that a family pays for their private health coverage may be more than if they participated in the Idaho Health Plan (Medicaid/CHIP). To find out how much you may have to pay if you choose private health insurance coverage, ask your employer (or insurance agent) for a summary plan description (SPD) that includes specific cost sharing amounts for services. You should also be aware that federal rules prohibit the Idaho Health Plan from charging you cost-sharing amounts that exceed five percent of your family's income for you or your child in a given year. In comparison, the limit on the cost-sharing under your private health insurance coverage may be more or less depending on the plan.
Where can my child receive a well-baby child checkup?
The best place for your child to get a check-up is from your family's regular doctor. If wellness exams (well-baby and well-child checkups) are not covered by your child's health insurance plan under the Access Card or Access to Health Insurance Program, your child can get check-ups at free clinics or a low-cost community health center. To find the location nearest you, please call the Idaho CareLine at 2-1-1 or (800) 926-2588 or visit them on the Web at www.idahocareline.org.