CHILD HEALTH PROGRAM Training Open Enrollment 2016

1. CHILD HEALTH PROGRAMTraining 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 1-800-255-5053 Hours: Monday-Friday 8AM - 4PM Or you may also email questions re: completing Child Health Program applications to: CHCO@kp.org (Subject line: ‘Application Question’)

3. Child Health Program Overview KP’s Charitable Health Coverage Operations in Oakland, CA determines eligibility and enrolls children in the Child Health Program (CHP) • 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

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 applyregardless 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, 2015 - January 31, 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 RequiredKP Individuals & Families (KPIF) application 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 RequiredKaiser Permanente Subsidy Eligibility Form Kaiser Permanente Subsidy Eligibility Form For eligibility determination for our Community Benefit subsidy which reduces Health Plan monthly payments and copays.

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

20. MM/DD/YYYY 2nd Child’s First Name 2nd Child’s Last Name 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. Parent’s First Name, Last Name $ If applicable Spouse/Domestic Partner’s First Name, Last Name If any Child applying for coverage is employed enter income information here page 5

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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. First Name of Authorized Person Last Name of Authorized Person EE# (four digits) Name of Organization 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 12904 Oakland, CA 94604 • Note: • Child Health Program duration is up to 12 months • Parent/guardian pays no more than $20 per month per childup to 3 children • Supporting documentation for income is required

29. Supporting Documents Proof of Income EMPLOYED Submit Paystubs Must be within 4 weeks from application date and must include the name of parent working and paystub dates Or1040 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. 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: www.saccourt.ca.gov/forms/docs/pr-023.pdf OR • Form GC-250, Letter of Guardianship DocumentApplicant provides this form, has to be approved by the court OR • Power of Attorney for a Minor ChildApplicant provides this form, requires notary signature

31. Application Denials Application Delays What Causes Denials and 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 1-800-255-5053 (TTY users dial 711) • 1-866-874-1793 (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 Email chco@kp.org 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 email questions re: completing Child Health Program applications to: chco@kp.org (Subject line: ‘Application Question’) For escalations (regarding an issue with your client’s application status): Evelyn Navarro Enrollment Specialist – evelyn.m.navarro@kp.org (Please do not share contact information with applicants, applicant family members, or prospective members)

34. Q & A Thank You

35. APPENDIX

36. Special Enrollment PeriodTRIGGERING 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 StanislausSan 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 KP Southern California Service Areas The following counties are in the Child Health Program Southern California service area: Imperial RiversideKern San BernardinoLos 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