H&W: Premium Assistance Under Medicaid and the Children’s Health Insurance Program (CHIP)

H&WIf you or your children are eligible for Medicaid or CHIP and even if you are eligible for health coverage from your employer – in our case, the Professional Musicians, Local 47, and Employers’ Health & Welfare Fund (the “Fund”) – your state may have a premium assistance program that can help pay for your children’s coverage, using funds from the that State’s Medicaid or CHIP programs. If you or your children aren’t eligible for Medicaid or CHIP, you won’t be eligible for these premium assistance programs but, nonetheless, you may be able to buy them (and yourself, if you have not qualified for coverage through the Fund) individual insurance coverage through the Health Insurance Marketplace. For more information, visit www.healthcare.gov.

If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below, contact your State Medicaid or CHIP office to find out if premium assistance is available for dependent children coverage.

If you or your dependents are NOT currently enrolled in Medicaid or CHIP, and you think you or any of your dependents might be eligible for either of these programs, please contact your State Medicaid or CHIP office or dial 1-877-KIDS NOW or www.insurekidsnow.gov to find out how to apply. If you qualify, you should also inquire if your state has a program that might help you pay the premiums for an employer-sponsored plan, such as the Fund.

If you or your dependents are eligible for premium assistance under Medicaid or CHIP, as well as eligible under your employer plan (in our case, the Fund), your employer must still allow you and your dependents to enroll in your employer plan if you are not already enrolled. This is called a “special enrollment” opportunity, and you must request coverage within 60 days of being determined eligible for premium assistance (this will require you providing a copy of the determination notice to the Fund within 60 days of any state determination that your child dependents are medicare/CHIP eligible). If you have questions about enrolling in your employer plan, contact the Department of Labor at www.askebsa.dol.gov or call 1-866-444-EBSA (3272).

For information about eligibility contact the California Department of Health and Human Services office by visiting www.dhcs.ca.gov/services/Pages/TPLRD_CAU_cont.aspx.

If you live in one of the following states, you may be eligible for assistance paying your employer health plan premiums. The following list of states is current as of January 31, 2016. Contact your State for more information on eligibility.

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To see if any other states have added a premium assistance program since January 31, 2016, or for more information on special enrollment rights, contact either:

U.S. Department of Labor
Employee Benefits Security Administration
www.dol.gov/ebsa
1-866-444-EBSA (3272)

U.S. Department of Health and Human Services
Centers for Medicare & Medicaid Services
www.cms.hhs.gov
1-877-267-2323, Menu Option 4, Ext. 61565