1. CHILD HEALTH PROGRAM Training Open Enrollment 2016
Charitable Health Coverage Operations (CHCO)

2. Agenda Overview Eligibility/Benefits
Child Health Program Applications Process
KP Individuals and Families (KPIF) Application
Kaiser Permanente Subsidy Eligibility Form
Q&A
* After our training session, you may contact Charitable Health Coverage Operations at
Hours: Monday-Friday 8AM - 4PM
Or you may also questions re: completing Child Health Program applications to:
(Subject line: ‘Application Question’)

3. Child Health Program Overview
The Child Health Program provides low-cost, comprehensive health care coverage for uninsured children.
Includes medical, dental and vision coverage
Monthly Payment: $0, $10 or $20 per child for up to three children
No copays at KP facilities
What makes CHP unique?
Non-citizen and undocumented children are eligible
Family income up to 300% of the Federal Poverty Level
KP’s Charitable Health Coverage Operations in Oakland, CA determines eligibility and enrolls children in the Child Health Program (CHP)

4. Open Enrollment 2016: November 1st, 2015- January 31st 2016
CHILD HEALTH PROGRAM
Available only outside of Covered California Exchange
Applications accepted only during open enrollment period unless there is a triggering event which qualifies for a special enrollment period
KP Individuals and Families (KPIF)
Platinum Plan
Kaiser Permanente Subsidy Eligibility Form
(monthly payment & copay)
Administered separately from KPIF
Lowers KPIF monthly payment amount
Reduces KPIF copay amounts to $0 (at KP facilities)
Pediatric Dental
Delta Care USA
Comprehensive dental services as per ACA
No separate premium
Applicants must meet eligibility criteria
Separate form
KP CA health plan
Platinum (metal tier) plan offers the most comprehensive coverage
Separate application
Plan oversight by DMHC (Department of Managed Health Care)

5. Child Health Program - Eligibility
Is for children with no access to health insurance.
Live in a Kaiser Foundation Health Plan, Inc. service area that is open to new enrollment.
Note: Children on Restricted (emergency) Medi-Cal are eligible.
Are under the age of 19.
Live in a household with incomes up to 300% of the Federal Poverty Level
Don’t have access to any other public or private health coverage including but not limited to Medi-Cal, Medicare, Covered California, or a job-based health plan.
No proof of U.S. citizenship is required. Children can apply regardless of the
legal status of the parent(s).

6. Child Health Program - Eligibility

7. Child Health Program – Summary of Benefits

8. Effective Dates for New Applicants
Open Enrollment: November 1, January 31, 2016
Application Received Date
Effective Date of Coverage
November 1- December 15
January, 1, 2016
December 16-January 15
February 1, 2016
Jan 16-Jan 31
March 1, 2016
Note: 1/31/16 falls on a Sunday. All applications must be in the office by 5pm 2/1/16.

9. Child Health Program - 2 Applications Required KP Individuals & Families (KPIF) application
For regulated Health Plan offered by Kaiser (i.e., KPIF Platinum Plan).
Applicant can get same plan on the exchange (Covered CA), but our Community Benefit subsidy would not be available there.

10. Child Health Program - 2 Applications Required Kaiser Permanente Subsidy Eligibility Form
For eligibility determination for our
Community Benefit subsidy which reduces
Health Plan monthly payments and copays.

11. page 1

12. page 2

13. page 3

14. page 4

15. page 5

17. page 1

18. page 2

19. Child’s First Name
Child’s Last Name
MM/DD/YYYY
Required:
Answer all questions
page 3

20. 2nd Child’s First Name
2nd Child’s Last Name
MM/DD/YYYY
Required:
Answer all questions
Name of school if applicant is a student
page 3

21. 3rd Child’s First Name
3rd Child’s First Name
MM/DD/YYYY
Required:
Answer all questions
Name of school if applicant is a student
page 4

22. 4th Child’s First Name
4th Child’s First Name
MM/DD/YYYY
Required:
Answer all questions
Name of school if applicant is a student
page 4

23. #
Child’s First Name, Last Name
page 4

24. If applicable Parent’s First Name, Last Name $
Spouse/Domestic Partner’s First Name, Last Name
If any Child applying for coverage is employed enter income information here
page 5

25. page 5

26. Answer required
First and Last Name of Parent/Legal Guardian/ or 18 year old applicant
Signature of Parent/Legal Guardian/ or 18 year old applicant
MM/DD/YYYY
page 6

27. page 6 First Name of Authorized Person Last Name of Authorized Person
Name of Organization
EE# (four digits)
First and Last Name of Parent/Legal Guardian/ or 18 year old applicant
Signature of Parent/Legal Guardian/ or 18 year old applicant
MM/DD/YYYY
page 6

28. NEXT STEPS
Sign both the KPIF Application and the KP Subsidy Eligibility Form and mail them with required documentation to: Charitable Health Coverage Operations Kaiser Permanente PO Box Oakland, CA 94604
Note:
Child Health Program duration is up to 12 months
Parent/guardian pays no more than $20 per month per child up to 3 children
Supporting documentation for income is required

29. Supporting Documents Proof of Income OR EMPLOYED
Submit Paystubs Must be within 4 weeks from application date and must
include the name of parent working and paystub dates
Or 1040 tax return
SELF-EMPLOYED
Complete Profit & Loss Statement (included in
the enrollment kit)
3 month history OR 1040 tax return with schedule page
CASH SALARY
Submit letter from employer
Company letterhead and statement
How much applicant is paid and how often OR
Complete an Affidavit form
Company Letterhead
Statement that applicant works for XYZ employer
How much applicant is paid
How often applicant is paid

30. Proof of Guardianship (if required)
Supporting Documents
Proof of Guardianship (if required)
Kaiser Permanente accepts :
California Caregiver Authorization Affidavit (Does not require an attorney or a notary) See form in your binder or go to: OR
Form GC-250, Letter of Guardianship Document Applicant provides this form, has to be approved by the court
Power of Attorney for a Minor Child Applicant provides this form, requires notary signature

31. What Causes Denials and Delays?
Application Denials
Application Delays
No signature or incorrect signature (Example - unmatched signature or single signature)
No date on application or outdated app
Lack of or incomplete income documentation
Lack of guardianship documentation (if required)
Home address with P.O. Box (P.O. Box okay for mailing documents)
Missing date of birth of child
Unclear documentation (Example - unreadable handwriting)
Over age limit
Over income limit
Resides out of service area
Application comes from a county closed to new enrollment
Has other active group coverage or eligible for other coverage
Applying outside of Open Enrollment without a triggering event
Late Mailing – Missing received date cut off

32. RESOURCES Child Health Program site: info.kp.org/childhealthprogram
This site contains new program information, applications, forms, etc.
Charitable Health Coverage Operations
Hours of Operation: Monday-Friday 8:AM – 4PM (TTY users dial 711)
(Fax)
Kaiser Permanente
P.O. Box 12904
Oakland, CA 94604

33. Resources Cont.
Child Health Program “Community Partner support page" site: kp.org/childhealthprogram/support
This page contains an updated FAQ document and link to a training presentation (you can listen to the CHP Training Webinar and view the CHP Training Webinar Presentation). 
To request Child Health Program Enrollment Application Kits
and include:
Your name, Agency/Organization, Street Address, City, State Zip, Phone Number
Quantity of English and/or Spanish Child Health Program Enrollment Application Kits
You may also questions re: completing Child Health Program applications to:
(Subject line: ‘Application Question’)
For escalations (regarding an issue with your client’s application status):
Evelyn Navarro Enrollment Specialist –
(Please do not share contact information with applicants, applicant family members, or prospective members)

34. Q & A
Thank You

35. APPENDIX

36. Special Enrollment Period TRIGGERING EVENTS
You have moved to a new location and have different choice of plans
Marriage
Birth or adoption of a child
Divorce
Loss of job and job-based health coverage

37. KP Northern California Service Areas
The following counties are in the Northern California service area:
Alameda San Joaquin Contra Costa San Mateo Marin Solano Sacramento Stanislaus San Francisco Portions of the following counties are in the Northern California service area:
Amador Placer El Dorado Santa Clara Fresno Sonoma Kings Sutter Madera Tulare Mariposa Yolo Napa Yuba

38. KP Southern California Service Areas
The following counties are in the Child Health Program Southern California service area:
Imperial Riverside Kern San Bernardino Los Angeles San Diego
Orange* Ventura
*All Zip Codes in Orange County are eligible. A complete list of eligible zip codes is available at info.kp.org/childhealthprogram
Counties Currently Open:
Imperial
Los Angeles (except Antelope Valley)
Orange
Riverside
San Bernardino
San Diego