Page 24 - Benefits at a Glance Guide 2021-2022

Required Annual Employee Disclosure Notices

Premium Assistance Under Medicaid and the
Children’s Health Insurance Program (CHIP)

If you or your children areeligible for Medicaid or CHIP andyou’re eligible for health coveragefrom your employer, your state
may haveapremium assistance program thatcan help payfor coverage, using funds from their 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 you may
be able to buy 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.

If you or your dependents areN O T currently enrolled in Medicaid or CHIP, andyou think you or anyof 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, askyour stateif it hasaprogram 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, youremployer must allowyou to enroll in youremployer plan if you aren’t alreadyenrolled. This is called a“special
enrollment” opportunity, andyou must request coverage within 60 days of being determined eligible for premium
assistance. If you havequestions about enrolling in your employer plan, contact the Department of Labor at
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-Medicaid CALIFORNIA-Medicaid
Website: Website:
http://myalhipp.com/ Phone: Health Insurance Premium Payment (HIPP) Program
1-855-692-5447 http://dhcs.ca.gov/hipp
Phone: 916-445-8322
Email: hipp@dhcs.ca.gov
ALASKA-Medicaid COLORADO-Health First Colorado
(Colorado’s Medicaid Program) & Child
Health Plan Plus (CHP+)
The AK Health Insurance Premium Payment Program Health First Colorado Website:
Website: http://myakhipp.com/ https://www.healthfirstcolorado.com/
Phone: 1-866-251-4861 Health First Colorado Member Contact Center: 1-
Email: CustomerService@MyAKHIPP.com Medicaid 800-221-3943/ State Relay 711
Eligibility: CH P +: https://www.colorado.gov/pacific/hcpf/child-
http://dhss.alaska.gov/dpa/Pages/medicaid/default.aspx health-plan-plus
C H P + Customer Service: 1-800-359-1991/State Relay 711
Health Insurance Buy-In Program (HIBI):
https://www.colorado.gov/pacific/hcpf/health-insurance-buy-
program
HIBI Customer Service: 1-855-692-6442
ARKANSAS-Medicaid FLORIDA-Medicaid
Website: http://myarhipp.com/ Website:
Phone: 1-855-MyARHIPP (855-692-7447) https://www.flmedicaidtplrecovery.com/flmedicaidtplrecov
ery.com/hipp/index.html
Phone: 1-877-357-3268

23