Averitt Express_2024 FlexForce Guide

Premium Assistance Under Medicaid and the Children’s Health Insurance Program (CHIP) If you or your children are eligible for Medicaid or CHIP and you’re eligible for health coverage from your employer, your state may have a premium assistance program that can help pay for 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 are NOT currently enrolled in Medicaid or CHIP, and you think you or any of 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, ask your state if it has a program 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, your employer must allow you to enroll in your employer plan if you aren’t already enrolled. This is called a “special enrollment” opportunity, and you must request coverage within 60 days of being determined eligible for premium assistance. If you have questions 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 July 31, 2023. Contact your State for more information on eligibility.

ALABAMA: Medicaid myalhipp.com 855-692-5447 ALASKA: Medicaid The AK Health Insurance Premium Payment Program: myakhipp.com 866-251-4861 CustomerService@MyAKHIPP.com Medicaid Eligibility: https://health.alaska.gov/dpa/ ARKANSAS: Medicaid myarhipp.com 855-MyARHIPP (855-692-7447) CALIFORNIA: Medicaid

INDIANA: Medicaid Healthy Indiana Plan for low-income adults 19-64: in.gov/fssa/hip 877-438-4479 All other Medicaid: https://www.in.gov/medicaid 800-457-4584 IOWA: Medicaid and CHIP (Hawki) Medicaid: https://dhs.iowa.gov/ ime/members 800-338-8366 Hawki: dhs.iowa.gov/Hawki 800-257-8563 HIPP: https://dhs.iowa.gov/ime/ members/medicaid-a-to-z/hipp 888-346-9562 KANSAS: Medicaid https://www.kancare.ks.gov Kentucky Integrated Health Insurance Premium Payment Program (KI-HIPP): https://chfs. ky.gov/agencies/dms/member/ Pages/kihipp.aspx 855-459-6328 KIHIPP.PROGRAM@ky.gov KCHIP: https://kidshealth.ky.gov 877-524-4718 Kentucky Medicaid: https://chfs. ky.gov LOUISIANA: Medicaid Medicaid: medicaid.la.gov 888-342-6207 LaHIPP: ldh.la.gov/lahipp 855-618-5488 MAINE: Medicaid https://www. mymaineconnection.gov/ benefits/s 800-442-6003 (TTY: Maine relay 711) Private Health Insurance Premium Webpage: https:// www.maine.gov/dhhs/ofi/ applications-forms 800-977-6740 (TTY: Maine relay 711) 800-792-4884 800-967-4660 KENTUCKY: Medicaid

MASSACHUSETTS: Medicaid and CHIP https://www.mass.gov/ masshealth/pa 800-862-4840 (TTY: 617-886-8102) masspremiumassistance@ accenture.com MINNESOTA: Medicaid https://mn.gov/dhs/people-we- serve/children-and-families/ health-care/health-care- programs/programs-and- services/other-insurance.jsp 800-657-3739 MISSOURI: Medicaid dss.mo.gov/mhd/participants/ pages/hipp.htm 573-751-2005 MONTANA: Medicaid dphhs.mt.gov/Montana HealthcarePrograms/HIPP 800-694-3084 HHSHIPPProgram@mt.gov NEBRASKA: Medicaid ACCESSNebraska.ne.gov 855-632-7633

NORTH CAROLINA: Medicaid https://medicaid.ncdhhs.gov 919-855-4100 NORTH DAKOTA: Medicaid https://www.hhs.nd.gov/ healthcare 844-854-4825 OKLAHOMA: Medicaid and CHIP insureoklahoma.org 888-365-3742 OREGON: Medicaid healthcare.oregon.gov 800-699-9075 PENNSYLVANIA: Medicaid Medicaid: https://www.dhs. pa.gov/Services/Assistance/ Pages/HIPP-Program.aspx 800-692-7462 CHIP: https://www.dhs.pa.gov/ CHIP/Pages/CHIP.aspx 800-986-KIDS (5437) RHODE ISLAND: Medicaid and CHIP eohhs.ri.gov 855-697-4347, or 401-462-0311 (Direct RIte Share Line)

VIRGINIA: Medicaid and CHIP https://coverva.dmas.virginia. gov/learn/premium-assistance/ famis-select https://coverva.dmas.virginia. gov/learn/premium-assistance/ health-insurance-premium- payment-hipp-programs Medicaid: 800-432-5924 CHIP: 800-432-5924 WASHINGTON: Medicaid https://www.hca.wa.gov 800-562-3022 WEST VIRGINIA: Medicaid and CHIP https://dhhr.wv.gov/bms mywvhipp.com Medicaid: 304-558-1700 CHIP: 855-MyWVHIPP (855-699-8447) WISCONSIN: Medicaid and CHIP https://www.dhs.wisconsin.gov/ badgercareplus/p-10095.htm 800-362-3002 WYOMING: Medicaid

Health Insurance Premium Payment (HIPP) Program: dhcs.ca.gov/hipp 916-445-8322

Fax: 916-440-5676 hipp@dhcs.ca.gov

COLORADO: Health First Colorado (Colorado’s Medicaid Program) & Child Health Plan Plus (CHP+) Health First Colorado: https://www.healthfirstcolorado.com 800-221-3943/ State Relay 711 CHP+: https://hcpf.colorado. gov/child-health-plan-plus 800-359-1991, State Relay 711 Health Insurance Buy-In Program (HIBI): https://www.mycohibi.com 855-692-6442 FLORIDA: Medicaid https://www. flmedicaidtplrecovery.com/ flmedicaidtplrecovery.com/hipp 877-357-3268 GEORGIA: Medicaid GA HIPP: https://medicaid. georgia.gov/health-insurance- premium-payment-program-hipp 678-564-1162, Press 1 GA CHIPRA: https://medicaid. georgia.gov/programs/third- party-liability/childrens- health-insurance-program- reauthorization-act-2009-chipra 678-564-1162, Press 2

https://health.wyo.gov/ healthcarefin/medicaid/ programs-and-eligibility 800-251-1269

Lincoln: 402-473-7000 Omaha: 402-595-1178 NEVADA: Medicaid

SOUTH CAROLINA: Medicaid https://www.scdhhs.gov 888-549-0820 SOUTH DAKOTA: Medicaid dss.sd.gov 888-828-0059 TEXAS: Medicaid

To see if any other states have added a premium assistance program since July 31, 2023, or for more information on special enrollment rights, contact: U.S. Department of Labor Employee Benefits Security Administration dol.gov/agencies/ebsa 866-444-EBSA (3272)

dhcfp.nv.gov 800-992-0900

NEW HAMPSHIRE: Medicaid https://www.dhhs.nh.gov/

programs-services/medicaid/ health-insurance-premium- program 603-271-5218 Toll free number for HIPP: 800-852-3345, ext 5218 NEW JERSEY: Medicaid and CHIP Medicaid: state.nj.us/ humanservices/dmahs/clients/ medicaid 609-631-2392 CHIP: njfamilycare.org/index.html 800-701-0710 NEW YORK: Medicaid https://www.health.ny.gov/ health_care/medicaid 800-541-2831

https://www.hhs.texas.gov/ services/financial/health- insurance-premium-payment- hipp-program 800-440-0493 UTAH: Medicaid and CHIP Medicaid: https://medicaid. utah.gov CHIP: health.utah.gov/chip 877-543-7669 VERMONT: Medicaid https://dvha.vermont.gov/ members/medicaid/hipp- program 800-250-8427

OR

U.S. Department of Health and Human Services Centers for Medicare & Medicaid Services cms.hhs.gov 877-267-2323, Menu Option 4, Ext. 61565

OMB Control Number 1210-0137 (expires 1/31/2026)

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