INDIANA Medicaid
VIRGINIA Medicaid and CHIP
Healthy Indiana Plan for low-income adults 19-64 Website: http://www.in.gov/fssa/hip/ Phone: 1-877-438-4479 All other Medicaid Website: https://www.in.gov/medicaid/ Phone 1-800-457-4584
Website: https://coverva.dmas.virginia.gov/ learn/premium-assistance/famis-select Phone: 1-800-692-7462
https://coverva.dmas.virginia.gov/learn/ premium-assistance/health-insurance- premium-payment-hipp-programs Medicaid/ CHIP Phone: 1-432-5924 MASSACHUSETTS Medicaid and CHIP PENNSYLVANIA Medicaid AND CHIP Website: https://www.mass.gov/masshealth/ pa Phone: 1-800-862-4840 TTY: (617) 886-8102 Email: masspremassistance@accenture.com Website: https://www.dhs.pa.gov/Services/ Assistance/Pages/HI PP-Program.aspx Phone: 1-800-692-7462 CHIP Website: Children’s Health Insurance Program (CHIP) (pa.gov) CHIP Phone: 1-800-986-KIDS (5437) To see if any other states have added a premium assistance program since July 31, 2022, or for more information on special enrollment rights, contact either:
U.S. Department of Labor Employee Benefits Security Administration
U.S. Department of Health and Human Services Centers for Medicare & Medicaid Services www.cms.hhs.gov 1-877-267-2323, Menu Option 4, Ext. 61565
www.dol.gov/agencies/ebsa 1-866-444-EBSA (3272)
OMB Control Number 1210-0137 (expires 1/31/2026)
EFFECTIVE DATE OF THIS NOTICE
This Notice is effective as of January 1, 2025.
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