R382-10-4. Applicant and Enrollee Rights and Responsibilities

  (1) A parent or an adult who assumes responsibility for the care or supervision of a child may apply or reapply for CHIP benefits on behalf of a child. A child who is independent may apply on his own behalf.

  (2) If a person needs assistance to apply, the person may request assistance from a friend, family member, the eligibility agency, or outreach staff.

  (3) The applicant must provide verification requested by the eligibility agency to establish the eligibility of the child, including information about the parents.

  (4) Anyone may look at the eligibility policy manuals located on-line or at any eligibility agency office, except at outreach or telephone locations.

  (5) If the eligibility agency determines that the child received CHIP coverage during a period when the child was not eligible for CHIP, the parent, child, or legal guardian who arranges for medical services on behalf of the child must repay the Department for the cost of services.

  (6) The parent or child, or other responsible person acting on behalf of a child must report certain changes to the eligibility agency.

  (a) The following changes are reportable within 10 calendar days of the day of the change:

  (i) An enrollee begins to receive coverage or to have access to coverage under a group health plan or other health insurance coverage;

  (ii) An enrollee leaves the household or dies;

  (iii) An enrollee or the household moves out of state;

  (iv) Change of address of an enrollee or the household; and

  (v) An enrollee enters a public institution or an institution for mental diseases.

  (b) Certain changes are reportable as part of the review process if these changes occurred anytime during the certification period and before the 10-day notice due date in the review month. A change in the following must be reported as part of the review process for any household member:

  (i) Income source;

  (ii) Gross income of $25 or more;

  (iii) Tax filing status;

  (iv) Pregnancy or termination of a pregnancy;

  (v) Number of dependents claimed as tax dependents;

  (vi) Earnings of a child;

  (vii) Marital status; and

  (viii) Student status of a child under 24 years of age.

  (7) An applicant and enrollee may review the information that the eligibility agency uses to determine eligibility.

  (8) An applicant and enrollee have the right to be notified about actions that the agency takes to determine their eligibility or continued eligibility, the reason the action was taken, and the right to request an agency conference or agency action as defined in Section R414-301-6 and Section R414-301-7.

  (9) An enrollee in CHIP must pay quarterly premiums to the agency, and co-payments or co-insurance amounts to providers for medical services that the enrollee receives under CHIP.