ࡱ>  H+bjbj 7ee+# 22222FFF8~Z4F2@-%%4&y2{2{2{2{2{2{2$4t722( %"-%((222-2---(22y2-(y2---J}h)^-e2202-7)7--\72-t+&Lw&6-&,&*+&+&+&22++&+&+&2((((7+&+&+&+&+&+&+&+&+& :  Premium Assistance Under Medicaid and the Childrens Health Insurance Program (CHIP) If you or your children are eligible for Medicaid or CHIP and youre eligible for health coverage from your employer, your state may have a premium assistance program that can help pay for coverage, using funds from their Medicaid or CHIP programs. If you or your children arent eligible for Medicaid or CHIP, you wont be eligible for these premium assistance programs but you may be able to buy individual insurance coverage through the Health Insurance Marketplace. For more information, visit  HYPERLINK "http://www.healthcare.gov" 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. 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, 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, ask your state if it has a program that might help you pay the premiums for an employer-sponsored plan. If you or your dependents are eligible for premium assistance under Medicaid or CHIP, as well as eligible under your employer plan, your employer must allow you to enroll in your employer plan if you arent already enrolled. This is called a special enrollment opportunity, and you must request coverage within 60 days of being determined eligible for premium assistance. If you have questions about enrolling in your employer plan, contact the Department of Labor at  HYPERLINK "http://www.askebsa.dol.gov" www.askebsa.dol.gov or call 1-866-444-EBSA (3272).  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 ALABAMA MedicaidGEORGIA Medicaid Website:  HYPERLINK "http://myalhipp.com/" http://myalhipp.com/ Phone: 1-855-692-5447Website:  HYPERLINK "http://dch.georgia.gov/medicaid" http://dch.georgia.gov/medicaid - Click on Health Insurance Premium Payment (HIPP) Phone: 404-656-4507ALASKA MedicaidINDIANA Medicaid Website:  HYPERLINK "http://health.hss.state.ak.us/dpa/programs/medicaid/" http://health.hss.state.ak.us/dpa/programs/medicaid/ Phone (Outside of Anchorage): 1-888-318-8890 Phone (Anchorage): 907-269-6529Healthy Indiana Plan for low-income adults 19-64 Website:  HYPERLINK "http://www.hip.in.gov" http://www.hip.in.gov Phone: 1-877-438-4479 All other Medicaid Website:  HYPERLINK "http://www.indianamedicaid.com" http://www.indianamedicaid.com Phone 1-800-403-0864COLORADO Medicaid IOWA Medicaid Medicaid Website:  HYPERLINK "http://www.colorado.gov/hcpf" http://www.colorado.gov/hcpf Medicaid Customer Contact Center: 1-800-221-3943Website:  HYPERLINK "http://www.dhs.state.ia.us/hipp/" http://www.dhs.state.ia.us/hipp/ Phone: 1-888-346-9562FLORIDA MedicaidKANSAS MedicaidWebsite:  HYPERLINK "http://flmedicaidtplrecovery.com/hipp/" http://flmedicaidtplrecovery.com/hipp/ Phone: 1-877-357-3268Website:  HYPERLINK "http://www.kdheks.gov/hcf/" http://www.kdheks.gov/hcf/ Phone: 1-785-296-3512  KENTUCKY MedicaidNEW HAMPSHIRE MedicaidWebsite:  HYPERLINK "http://chfs.ky.gov/dms/default.htm" http://chfs.ky.gov/dms/default.htm Phone: 1-800-635-2570Website:  HYPERLINK "http://www.dhhs.nh.gov/oii/documents/hippapp.pdf" http://www.dhhs.nh.gov/oii/documents/hippapp.pdf Phone: 603-271-5218LOUISIANA MedicaidNEW JERSEY Medicaid and CHIPWebsite:  HYPERLINK "http://dhh.louisiana.gov/index.cfm/subhome/1/n/331" http://dhh.louisiana.gov/index.cfm/subhome/1/n/331 Phone: 1-888-695-2447Medicaid Website:  HYPERLINK "http://www.state.nj.us/humanservices/dmahs/clients/medicaid/" http://www.state.nj.us/humanservices/ dmahs/clients/medicaid/ Medicaid Phone: 609-631-2392 CHIP Website:  HYPERLINK "http://www.njfamilycare.org/index.html" http://www.njfamilycare.org/index.html CHIP Phone: 1-800-701-0710MAINE MedicaidNEW YORK Medicaid Website:  HYPERLINK "http://www.maine.gov/dhhs/ofi/public-assistance/index.html" http://www.maine.gov/dhhs/ofi/public-assistance/index.html Phone: 1-800-442-6003 TTY: Maine relay 711Website:  HYPERLINK "http://www.nyhealth.gov/health_care/medicaid/" http://www.nyhealth.gov/health_care/medicaid/ Phone: 1-800-541-2831MASSACHUSETTS Medicaid and CHIPNORTH CAROLINA Medicaid Website:  HYPERLINK "http://www.mass.gov/MassHealth" http://www.mass.gov/MassHealth Phone: 1-800-462-1120Website:  HYPERLINK "http://www.ncdhhs.gov/dma" http://www.ncdhhs.gov/dma Phone: 919-855-4100MINNESOTA MedicaidNORTH DAKOTA MedicaidWebsite:  HYPERLINK "http://mn.gov/dhs/ma/" http://mn.gov/dhs/ma/ Phone: 1-800-657-3739Website:  HYPERLINK "http://www.nd.gov/dhs/services/medicalserv/medicaid/" http://www.nd.gov/dhs/services/medicalserv/medicaid/ Phone: 1-844-854-4825MISSOURI MedicaidOKLAHOMA Medicaid and CHIPWebsite:  HYPERLINK "http://www.dss.mo.gov/mhd/participants/pages/hipp.htm" http://www.dss.mo.gov/mhd/participants/pages/hipp.htm Phone: 573-751-2005Website:  HYPERLINK "http://www.insureoklahoma.org" http://www.insureoklahoma.org Phone: 1-888-365-3742MONTANA MedicaidOREGON Medicaid Website:  HYPERLINK "http://dphhs.mt.gov/MontanaHealthcarePrograms/HIPP" http://dphhs.mt.gov/MontanaHealthcarePrograms/HIPP Phone: 1-800-694-3084Website:  HYPERLINK "http://www.oregonhealthykids.gov" http://www.oregonhealthykids.gov  HYPERLINK "http://www.hijossaludablesoregon.gov" http://www.hijossaludablesoregon.gov Phone: 1-800-699-9075NEBRASKA MedicaidPENNSYLVANIA MedicaidWebsite:  HYPERLINK "http://dhhs.ne.gov/Children_Family_Services/AccessNebraska/Pages/accessnebraska_index.aspx" http://dhhs.ne.gov/Children_Family_Services/AccessNebraska/Pages/accessnebraska_index.aspx Phone: 1-855-632-7633 Website:  HYPERLINK "http://www.dhs.pa.gov/hipp" http://www.dhs.pa.gov/hipp Phone: 1-800-692-7462 NEVADA MedicaidRHODE ISLAND MedicaidMedicaid Website:  HYPERLINK "http://dwss.nv.gov/" http://dwss.nv.gov/ Medicaid Phone: 1-800-992-0900Website:  HYPERLINK "http://www.eohhs.ri.gov/" http://www.eohhs.ri.gov/ Phone: 401-462-5300SOUTH CAROLINA MedicaidVIRGINIA Medicaid and CHIPWebsite:  HYPERLINK "http://www.scdhhs.gov" http://www.scdhhs.gov Phone: 1-888-549-0820Medicaid Website:  HYPERLINK "http://www.coverva.org/programs_premium_assistance.cfm" http://www.coverva.org/programs_premium_assistance.cfm Medicaid Phone: 1-800-432-5924 CHIP Website:  HYPERLINK "http://www.coverva.org/programs_premium_assistance.cfm" http://www.coverva.org/programs_premium_assistance.cfm CHIP Phone: 1-855-242-8282SOUTH DAKOTA - MedicaidWASHINGTON MedicaidWebsite:  HYPERLINK "http://dss.sd.gov" http://dss.sd.gov Phone: 1-888-828-0059Website:  HYPERLINK "http://www.hca.wa.gov/medicaid/premiumpymt/pages/index.aspx" http://www.hca.wa.gov/medicaid/premiumpymt/pages/index.aspx Phone: 1-800-562-3022 ext. 15473TEXAS MedicaidWEST VIRGINIA MedicaidWebsite:  HYPERLINK "http://gethipptexas.com/" http://gethipptexas.com/ Phone: 1-800-440-0493Website:  HYPERLINK "http://www.dhhr.wv.gov/bms/Medicaid%20Expansion/Pages/default.aspx" http://www.dhhr.wv.gov/bms/Medicaid%20Expansion/Pages/default.aspx Phone: 1-877-598-5820, HMS Third Party LiabilityUTAH Medicaid and CHIPWISCONSIN Medicaid and CHIPWebsite: Medicaid:  HYPERLINK "http://health.utah.gov/medicaid" http://health.utah.gov/medicaid CHIP:  HYPERLINK "http://health.utah.gov/chip" http://health.utah.gov/chip Phone: 1-877-543-7669Website:  HYPERLINK "https://www.dhs.wisconsin.gov/publications/p1/p10095.pdf" https://www.dhs.wisconsin.gov/publications/p1/p10095.pdf Phone: 1-800-362-3002VERMONT MedicaidWYOMING MedicaidWebsite:  HYPERLINK "http://www.greenmountaincare.org/" http://www.greenmountaincare.org/ Phone: 1-800-250-8427Website:  HYPERLINK "https://wyequalitycare.acs-inc.com/" https://wyequalitycare.acs-inc.com/ Phone: 307-777-7531 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 U.S. Department of Health and Human Services Employee Benefits Security Administration Centers for Medicare & Medicaid Services  HYPERLINK "http://www.dol.gov/ebsa" www.dol.gov/ebsa  HYPERLINK "http://www.cms.hhs.gov/" www.cms.hhs.gov 1-866-444-EBSA (3272)  HYPERLINK 1-877-267-2323, Menu Option 4, Ext. 61565 OMB Control Number 1210-0137 (expires 10/31/2016)     PAGE  "#+,XY`q P S ֿ}yfSfS@SfSf@SfSf@f$h@#|hgxCJOJQJaJmH sH $h@#|hCJOJQJaJmH sH $h@#|hUCJOJQJaJmH sH hU&h.5B* OJQJ^JmH phOsH ,h@#|hU5B* OJQJ^JmH phOsH ,h@#|h5B* OJQJ^JmH phOsH ,h@#|h035B* OJQJ^JmH phOsH ,h@#|h5B* OJQJ^JmH phOsH $hC [hQ5B* OJQJ^JphO,XY T U !"$-A $$Ifa$gd c 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