Governor Wolf Ensures All CHIP Plans Meet Federal Requirements, PA Families Will Not Face Tax Penalties or Premium Increases

June 11, 2015

Harrisburg, PA – Governor Tom Wolf today announced that his administration has ensured that all CHIP full cost health insurance plans, those under which families pay the entire premium, now meet minimum essential coverage requirements of the Affordable Care Act (ACA). This guarantees families in this program will not face tax penalties for 2015. The governor also said these families will see no premium increases during the current policy year.

“My first day in office I confronted the news that the families of 3,600 children in Pennsylvania’s CHIP full cost plans faced tax penalties for 2014 and 2015 because these plans did not meet the minimum essential coverage requirements of the Affordable Care Act,” said Governor Wolf.  “I acted immediately and worked with Commissioner Miller to get the federal government to provide hardship waivers for these families for 2014, and to give us time beyond the February 15th deadline, to work with families and our CHIP insurers to bring 2015 plans into compliance. I am pleased to announce that all these health plans now meet the federal requirements, no tax penalties will be assessed to any Pennsylvania CHIP families, and these families will not face any premium increases for their coverage during the current policy year.”

In his second week in office, Governor Wolf announced that his administration acted swiftly to protect Pennsylvania families enrolled in the CHIP Buy-in Plan, after the federal government had determined the Buy-In Plan did not meet minimum essential coverage (MEC). As a result, families would be forced to find new plans and would have face tax penalties. Shortly after that, the governor announced that the federal government would allow time for the Insurance Department to work with insurance companies to bring all CHIP plans into compliance with MEC so families would not lose coverage or face tax penalties.

CHIP provides health insurance to children under age 19 who don’t qualify for Medical Assistance. Currently, more than 147,000 Pennsylvania children are enrolled in the program.  All CHIP insurers have started the process of updating their computer systems to reflect enhanced benefits that meet federal requirements under the ACA. The Insurance Department expects all insurers to have their systems updated to implement the added benefits by July 1.

“Governor Wolf is committed to increasing the availability of health insurance, and his leadership made this announcement possible today, along with the partnership of our insurance vendors,” said Insurance Commissioner Teresa Miller.  “The winners are the children who continue to benefit from CHIP coverage, and families who can get this coverage at rates they can afford.”

Among the additional benefits included in full cost CHIP plans under the ACA are a prohibition on annual and lifetime dollar limitations for specific services classified as essential health benefits. Covered items include durable medical equipment, hearing aids, pediatric vision and dental services, including orthodontic services. Prior to the minimum essential coverage requirements for full cost CHIP plans, there were limits such as $1,500 per year for dental and orthodontic care, $5,000 per year for durable medical equipment, and $120 a year for glasses.

Many preventive care services must be provided without cost sharing, such as co-payments, coinsurance, or deductibles. Some of these services are plaque control programs, oral hygiene education, dietary instruction, genetic counseling, and prescribed iron supplementation.  Prescription drug benefits must cover over the counter drugs, vitamins, and aspirin. Health plans must also provide parity between mental health/substance use disorder benefits, and medical/surgical benefits.

For more information on CHIP, visit www.CHIPcoversPAkids.com, or call -1-800-896-KIDS.

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