ࡱ> g I<bjbj** 4HibHib,4 FFFFFZZZ8^DZ94`    (((3333333$583F(("(((3FF  3r)r)r)(F F 3r)(3r)r)r) `y>)4r)3 4094r)-9r)-9r),)n-9F * ((r)(((((33r)(((94((((-9((((((((( B : 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  HYPERLINK "http://www.insurekidsnow.gov" 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, 2021. Contact your State for more information on eligibility ALABAMA MedicaidCOLORADO Health First Colorado (Colorados Medicaid Program) & Child Health Plan Plus (CHP+)Website:  HYPERLINK "http://myalhipp.com/" http://myalhipp.com/ Phone: 1-855-692-5447Health First Colorado Website:  HYPERLINK "https://www.healthfirstcolorado.com/" https://www.healthfirstcolorado.com/ Health First Colorado Member Contact Center: 1-800-221-3943/ State Relay 711 CHP+:  HYPERLINK "https://www.colorado.gov/pacific/hcpf/child-health-plan-plus" https://www.colorado.gov/pacific/hcpf/child-health-plan-plus CHP+ Customer Service: 1-800-359-1991/ State Relay 711 Health Insurance Buy-In Program (HIBI):  HYPERLINK "https://www.colorado.gov/pacific/hcpf/health-insurance-buy-program" https://www.colorado.gov/pacific/hcpf/health-insurance-buy-program HIBICustomer Service: 1-855-692-6442ALASKA MedicaidFLORIDA MedicaidThe AK Health Insurance Premium Payment Program Website:  HYPERLINK "http://myakhipp.com/" http://myakhipp.com/ Phone: 1-866-251-4861 Email:  HYPERLINK "mailto:CustomerService@MyAKHIPP.com" CustomerService@MyAKHIPP.com Medicaid Eligibility:  HYPERLINK "http://dhss.alaska.gov/dpa/Pages/medicaid/default.aspx" http://dhss.alaska.gov/dpa/Pages/medicaid/default.aspxWebsite:  HYPERLINK "https://www.flmedicaidtplrecovery.com/flmedicaidtplrecovery.com/hipp/index.html" https://www.flmedicaidtplrecovery.com/flmedicaidtplrecovery.com/hipp/index.html Phone: 1-877-357-3268ARKANSAS MedicaidGEORGIA Medicaid Website:  HYPERLINK "http://myarhipp.com/" http://myarhipp.com/ Phone: 1-855-MyARHIPP (855-692-7447)Website:  HYPERLINK "https://gcc01.safelinks.protection.outlook.com/?url=https%3A%2F%2Fmedicaid.georgia.gov%2Fhealth-insurance-premium-payment-program-hipp&data=02%7C01%7Cstashlaw%40dch.ga.gov%7C98b18a96ce1b49d087f708d709449652%7C512da10d071b4b948abc9ec4044d1516%7C0%7C0%7C636988062560854968&sdata=7rziGawQfBKcW1N2%2Bdi2j8cyHpaCYURGdtF8Hk%2By6FM%3D&reserved=0" https://medicaid.georgia.gov/health-insurance-premium-payment-program-hipp Phone: 678-564-1162 ext 2131CALIFORNIA Medicaid INDIANA Medicaid Website: Health Insurance Premium Payment (HIPP) Program  HYPERLINK "http://dhcs.ca.gov/hipp" http://dhcs.ca.gov/hipp Phone: 916-445-8322 Email:  HYPERLINK "mailto:hipp@dhcs.ca.gov" hipp@dhcs.ca.govHealthy Indiana Plan for low-income adults 19-64 Website:  HYPERLINK "http://www.in.gov/fssa/hip/" http://www.in.gov/fssa/hip/ Phone: 1-877-438-4479 All other Medicaid Website:  HYPERLINK "https://www.in.gov/medicaid/" https://www.in.gov/medicaid/ Phone 1-800-457-4584 IOWA Medicaid and CHIP (Hawki)MONTANA MedicaidMedicaid Website:  HYPERLINK "https://dhs.iowa.gov/ime/members" https://dhs.iowa.gov/ime/members Medicaid Phone: 1-800-338-8366 Hawki Website: HYPERLINK "http://dhs.iowa.gov/Hawki"http://dhs.iowa.gov/Hawki Hawki Phone: 1-800-257-8563 HIPP Website:  HYPERLINK "https://dhs.iowa.gov/ime/members/medicaid-a-to-z/hipp" https://dhs.iowa.gov/ime/members/medicaid-a-to-z/hipp HIPP Phone: 1-888-346-9562Website:  HYPERLINK "http://dphhs.mt.gov/MontanaHealthcarePrograms/HIPP" http://dphhs.mt.gov/MontanaHealthcarePrograms/HIPP Phone: 1-800-694-3084KANSAS MedicaidNEBRASKA Medicaid Website:  HYPERLINK "https://www.kancare.ks.gov/" https://www.kancare.ks.gov/ Phone: 1-800-792-4884Website:  HYPERLINK "http://www.ACCESSNebraska.ne.gov" http://www.ACCESSNebraska.ne.gov Phone: 1-855-632-7633 Lincoln: 402-473-7000 Omaha: 402-595-1178 KENTUCKY MedicaidNEVADA MedicaidKentucky Integrated Health Insurance Premium Payment Program (KI-HIPP) Website:  HYPERLINK "https://chfs.ky.gov/agencies/dms/member/Pages/kihipp.aspx" https://chfs.ky.gov/agencies/dms/member/Pages/kihipp.aspx Phone: 1-855-459-6328 Email:  HYPERLINK "mailto:KIHIPP.PROGRAM@ky.gov" KIHIPP.PROGRAM@ky.gov KCHIP Website:  HYPERLINK "https://kidshealth.ky.gov/Pages/index.aspx" https://kidshealth.ky.gov/Pages/index.aspx Phone: 1-877-524-4718 Kentucky Medicaid Website:  HYPERLINK "https://chfs.ky.gov" https://chfs.ky.govMedicaid Website:  HYPERLINK "http://dhcfp.nv.gov" http://dhcfp.nv.gov Medicaid Phone: 1-800-992-0900 LOUISIANA MedicaidNEW HAMPSHIRE MedicaidWebsite:  HYPERLINK "http://dhh.louisiana.gov/index.cfm/subhome/1/n/331" www.medicaid.la.gov or  HYPERLINK "http://www.ldh.la.gov/lahipp" www.ldh.la.gov/lahipp Phone: 1-888-342-6207 (Medicaid hotline) or 1-855-618-5488 (LaHIPP) Website:  HYPERLINK "https://www.dhhs.nh.gov/oii/hipp.htm" https://www.dhhs.nh.gov/oii/hipp.htm Phone: 603-271-5218 Toll free number for the HIPP program: 1-800-852-3345, ext 5218MAINE MedicaidNEW JERSEY Medicaid and CHIPEnrollment Website:  HYPERLINK "https://www.maine.gov/dhhs/ofi/applications-forms" https://www.maine.gov/dhhs/ofi/applications-forms Phone: 1-800-442-6003 TTY: Maine relay 711 Private Health Insurance Premium Webpage:  HYPERLINK "https://www.maine.gov/dhhs/ofi/applications-forms" https://www.maine.gov/dhhs/ofi/applications-forms Phone: -800-977-6740. TTY: Maine relay 711Medicaid 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: 1-800-701-0710MASSACHUSETTS Medicaid and CHIPNEW YORK MedicaidWebsite:  HYPERLINK "https://www.mass.gov/info-details/masshealth-premium-assistance-pa" https://www.mass.gov/info-details/masshealth-premium-assistance-pa Phone: 1-800-862-4840Website:  HYPERLINK "https://www.health.ny.gov/health_care/medicaid/" https://www.health.ny.gov/health_care/medicaid/ Phone: 1-800-541-2831MINNESOTA MedicaidNORTH CAROLINA MedicaidWebsite:  HYPERLINK "http://mn.gov/dhs/people-we-serve/seniors/health-care/health-care-programs/programs-and-services/medical-assistance.jsp"   HYPERLINK "https://mn.gov/dhs/people-we-serve/children-and-families/health-care/health-care-programs/programs-and-services/other-insurance.jsp" https://mn.gov/dhs/people-we-serve/children-and-families/health-care/health-care-programs/programs-and-services/other-insurance.jsp Phone: 1-800-657-3739 Website:  HYPERLINK "https://medicaid.ncdhhs.gov/" https://medicaid.ncdhhs.gov/ Phone: 919-855-4100MISSOURI MedicaidNORTH DAKOTA MedicaidWebsite:  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.nd.gov/dhs/services/medicalserv/medicaid/" http://www.nd.gov/dhs/services/medicalserv/medicaid/ Phone: 1-844-854-4825 OKLAHOMA Medicaid and CHIPUTAH Medicaid and CHIPWebsite:  HYPERLINK "http://www.insureoklahoma.org/" http://www.insureoklahoma.org Phone: 1-888-365-3742Medicaid Website:  HYPERLINK "https://medicaid.utah.gov/" https://medicaid.utah.gov/ CHIP Website:  HYPERLINK "http://health.utah.gov/chip" http://health.utah.gov/chip Phone: 1-877-543-7669OREGON MedicaidVERMONT MedicaidWebsite:  HYPERLINK "http://healthcare.oregon.gov/Pages/index.aspx" http://healthcare.oregon.gov/Pages/index.aspx  HYPERLINK "http://www.oregonhealthcare.gov/index-es.html" http://www.oregonhealthcare.gov/index-es.html Phone: 1-800-699-9075Website:  HYPERLINK "http://www.greenmountaincare.org/" http://www.greenmountaincare.org/ Phone: 1-800-250-8427PENNSYLVANIA MedicaidVIRGINIA Medicaid and CHIPWebsite:  HYPERLINK "https://www.dhs.pa.gov/providers/Providers/Pages/Medical/HIPP-Program.aspx" https://www.dhs.pa.gov/providers/Providers/Pages/Medical/HIPP-Program.aspx Phone: 1-800-692-7462Website:  HYPERLINK "https://www.coverva.org/hipp/" https://www.coverva.org/hipp/ Medicaid Phone: 1-800-432-5924 CHIP Phone: 1-855-242-8282RHODE ISLAND Medicaid and CHIPWASHINGTON MedicaidWebsite:  HYPERLINK "http://www.eohhs.ri.gov/" http://www.eohhs.ri.gov/ Phone: 1-855-697-4347, or 401-462-0311 (Direct RIte Share Line)Website:  HYPERLINK "https://www.hca.wa.gov/" https://www.hca.wa.gov/ Phone: 1-800-562-3022SOUTH CAROLINA MedicaidWEST VIRGINIA MedicaidWebsite:  HYPERLINK "https://www.scdhhs.gov" https://www.scdhhs.gov Phone: 1-888-549-0820Website:  HYPERLINK "http://mywvhipp.com" http://mywvhipp.com/ Toll-free phone: 1-855-MyWVHIPP (1-855-699-8447)SOUTH DAKOTA - MedicaidWISCONSIN Medicaid and CHIPWebsite:  HYPERLINK "http://dss.sd.gov/" http://dss.sd.gov Phone: 1-888-828-0059Website:  HYPERLINK "https://www.dhs.wisconsin.gov/badgercareplus/p-10095.htm" https://www.dhs.wisconsin.gov/badgercareplus/p-10095.htm Phone: 1-800-362-3002TEXAS MedicaidWYOMING MedicaidWebsite:  HYPERLINK "http://gethipptexas.com/" http://gethipptexas.com/ Phone: 1-800-440-0493Website:  HYPERLINK "https://health.wyo.gov/healthcarefin/medicaid/programs-and-eligibility/" https://health.wyo.gov/healthcarefin/medicaid/programs-and-eligibility/ Phone: 1-800-251-1269 To see if any other states have added a premium assistance program since January 31, 2021, 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 "https://www.dol.gov/agencies/ebsa" www.dol.gov/agencies/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 Paperwork Reduction Act Statement According to the Paperwork Reduction Act of 1995 (Pub. L. 104-13) (PRA), no persons are required to respond to a collection of information unless such collection displays a valid Office of Management and Budget (OMB) control number. The Department notes that a Federal agency cannot conduct or sponsor a collection of information unless it is approved by OMB under the PRA, and displays a currently valid OMB control number, and the public is not required to respond to a collection of information unless it displays a currently valid OMB control number. See 44 U.S.C. 3507. Also, notwithstanding any other provisions of law, no person shall be subject to penalty for failing to comply with a collection of information if the collection of information does not display a currently valid OMB control number. See 44 U.S.C. 3512. The public reporting burden for this collection of information is estimated to average approximately seven minutes per respondent. Interested parties are encouraged to send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the U.S. Department of Labor, Employee Benefits Security Administration, Office of Policy and Research, Attention: PRA Clearance Officer, 200 Constitution Avenue, N.W., Room N-5718, Washington, DC 20210 or email  HYPERLINK "mailto:ebsa.opr@dol.gov" ebsa.opr@dol.gov and reference the OMB Control Number 1210-0137. 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