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 CH I P and you’re eligible for health coverage from your employer, your state may have apremium assistance program that can help pay for coverage, using funds from their Medicaid or CH I P 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 InsuranceMarketplace. For more information, visit www.healthcare.gov .
If you or your dependents are already enrolled in Medicaid or CH I P and you live in a State listed below, contact your State Medicaid or CH I P office to find out if premium assistance is available.
If you or your dependents areN O T 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 CH I P office or dial 1-877- KIDS NOW or www.insurekidsnow.gov to find out how to apply. If you qualify, askyour state if it has aprogram 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 allowyou 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 January 31, 2021. Contact your State for more information on eligibility –
ALABAMA-Medicaid
CALIFORNIA-Medicaid
Website: Health Insurance Premium Payment (HIPP) Program
Website: http://myalhipp.com/ Phone: 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+) Health First Colorado Website: https://www.healthfirstcolorado.com/ Health First Colorado Member Contact Center: 1- 800-221-3943/ State Relay 711 C H P + : https://www.colorado.gov/pacific/hcpf/child- 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
The AK Health Insurance Premium Payment Program Website: http://myakhipp.com/ Phone: 1-866-251-4861 Email: CustomerService@MyAKHIPP.com Medicaid Eligibility: http://dhss.alaska.gov/dpa/Pages/medicaid/default.aspx
ARKANSAS-Medicaid
FLORIDA-Medicaid
Website: http://myarhipp.com/ Phone: 1-855-MyARHIPP (855-692-7447)
Website: https://www.flmedicaidtplrecovery.com/flmedicaidtplrecov
ery.com/hipp/index.html Phone: 1-877-357-3268
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