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When a person chooses to end a child’s creditable health insurance coverage, the child cannot qualify for KidsCare for three months. The three months begins the day after the creditable coverage ends.
Exceptions:
The three-month period does not apply when:
· The creditable coverage was from another insurance affordability program.
· The premium to cover the child was more than 5 percent of the household income.
· The child's parent is eligible for advance payment of the premium tax credit to enroll in a QHP because the coverage the family had through an employer is determined unaffordable.
· The cost of family coverage that includes the child is more than 9.5 percent of the household income.
· The employer stopped offering coverage of dependents (or any coverage).
· The child lost coverage because of a family member’s job change.
· The child has special health care needs.
· The child lost coverage due to the death or divorce of a parent.
Term |
Definition |
Creditable coverage |
Health insurance coverage as defined under the Health Insurance Portability and Accountability Act (HIPAA). NOTE Eligibility for services through Indian Health Service (IHS) or a tribal organization is not considered creditable coverage. Examples of creditable coverage include: · Medicare; · Group health plans; · Health insurance coverage through a hospital or medical service policy, certificate or plan contract; or · Armed forces insurance, for example Tricare). |
Insurance affordability program |
AHCCCS Medical Assistance, Advance Premium Tax Credit (APTC) and Cost-Sharing Reductions (CSR) |
Children with special health care needs |
Children who have or are at risk for chronic physical, developmental, behavioral or emotional conditions that need health and related services of a type or amount beyond what children generally need. |
When the customer provides a coverage end date, accept the statement as proof unless there is information or proof that contradicts the statement.
When there is a discrepancy, proof of coverage end date includes:
· Phone call to the insurance company or agent, or the previous employer; or
· Written statement or documents from the insurance company or employer.
Proof that a child meets an exception to the three-month period depends on the type of exception. See below for examples of proof for the different types of exceptions.
Exception type… |
Proof includes… |
Coverage was from another insurance affordability program, or qualified for APTC because employer-sponsored insurance was unaffordable. |
Records from the Federally Facilitated Marketplace showing that the person was receiving APTC or CSR. |
The child-only premium was more than 5% of household income, OR The family premium was more than 9.5% of household income. |
· Check stubs (for income amount as well as the cost of the insurance if deducted from the income) · Phone call to the income source to confirm the amount · Written statement from the income source confirming an income amount or premium amount · Cancelled checks or other payment records that show the premium amount. · Phone call to the insurance company, agent or employer to confirm the premium amount. |
The employer stopped offering coverage, or the family member no longer works for the employer. |
· Written statement from the employer. · Phone call to the employer confirming that coverage is no longer offered or the person is no longer employed. · Unemployment Insurance records showing the person no longer works for the employer. |
The child lost coverage due to the death or divorce of a parent. |
· Vital Statistics death records · Other proof indicating a parent’s death (ex. an obituary from a newspaper) · Divorce decree or other court document |
The child has special health care needs. |
Written or verbal statement from the parent, guardian or child. |
This requirement applies to the following program:
Program |
Legal Authorities |
KidsCare |
42 CFR 457.805 ARS 36-2983 AAC R9-31-303(8) |