Children’s Health Insurance Program (CHIP) and Other Insurance Coverage –

Children’s Health Insurance Program (CHIP) and Other Insurance Coverage – Modified Adjusted Gross Income Programs A. Children who are covered by creditable third-party insurance at application are not eligible for CHIP. This is true regardless of who pays the health insurance premiums. Geographical access is taken into consideration when creditable coverage exists for a child. A CHIP child with creditable coverage but no geographical access to the coverage network cannot be denied CHIP. B. Creditable insurance coverage is full health insurance through a job-based health plan, private health insurance, Medicare, Medicaid, CHIP, CHAMPUS, TRICARE and veterans’ health coverage through the VA or the Health Insurance Marketplace and any health plan established or maintained by a state, the U.S. government or a foreign country or a state health insurance risk pool. C. Children with limited scope coverage are not considered to have creditable coverage; however, assignment of rights applies if CHIP pays for a benefit that is the legal liability of the limited third-party coverage that includes: accident insurance, disability income insurance, liability insurance, supplemental policies for liability insurance, worker’s compensation, automobile medical payment insurance, credit-only insurance, coverage for onsite medical clinics or limited-scope dental or vision or long-term care insurance. D. Termination of creditable coverage must be verified when the application indicates insurance coverage will terminate within the thirty (30) day application processing period or terminated within the six (6) months prior to the application. E. When creditable insurance coverage will terminate within the thirty (30) day application processing period, an otherwise CHIP-eligible child is not denied. F. If all other factors of eligibility will be met, the application will be held and action taken to approve the child after the insurance coverage has ended.