1308 KidsCare Application Process

 

 

Revised 01/15/2020

Policy

This section describes application requirements that are specific to the KidsCare program. 

·        No creditable coverage in the last three months

·        Past unpaid premiums

General information about the application process can be found in MA1301 and MA1302. 

1) No creditable coverage in the last three months

At application, if the customer has insurance coverage or has had coverage in the last three months the coverage must be reviewed to see if it is creditable.  If coverage has ended, the end-date must be verified.

2) Past unpaid premiums

When a customer’s KidsCare benefits end because premiums were not paid, the customer cannot get KidsCare for two months or the premiums are paid in full, whichever comes first.

 

Definitions

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 for KidsCare.

Examples of creditable coverage include:

·        Medicare;

·        Group health plans including Qualified Health Plans;

·        Health insurance coverage through a hospital or medical service policy, certificate or plan contract; or

·        Armed forces insurance (i.e., Tricare).

Non-Creditable Coverage

The following types of policies are considered non-creditable coverage:

·        Coverage only for accidents (including accidental death and dismemberment);

·        Liability insurance, including general liability and automobile liability insurance;

·        Free medical clinics at a work site;

·        Benefits with limited scope such as dental benefits, vision benefits or long term care benefits;

·        Coverage for a specific disease or illness (including cancer policies);

·        Insurance that pays a set amount a day when the person is hospitalized or unable to work.

 

Timeframes

See MA 1301B for the overall processing timeframe.

 

Legal Authority

Program

Legal Authorities

KidsCare

42 USC 1397jj(b)(1)(C)

42 CFR 457.310(b)(2)(ii);

42 CFR 457.805

ARS 36-2983(G)(2)