Insurance Benefits

Results: 7

• CHIP Programs (4)
  NL-5000.1500

  CHIP Programs

  NL-5000.1500
  
  Organizations that help families obtain health insurance for their children under the State Children's Health Insurance Program (SCHIP), a program that is jointly financed by the federal and state governments and administered by the states. In some states, CHIP is an expansion of the Medicaid program and allows children of parents with higher incomes than were allowable in the past to participate and receive health insurance through Medicaid. In other states, CHIP is a separate program from Medicaid and covers children whose parents have incomes that are higher than the state's Medicaid eligibility levels. Within broad Federal guidelines, each state determines the design of its program, eligibility groups, benefit packages, payment levels for coverage, and administrative and operating procedures. The insurance pays for doctor visits, immunizations, hospitalizations and emergency room visits, but additional services may be available depending on the benefits defined by the state. Depending on the family's income, insurance premiums and co-pays may apply.
• Health Insurance Market Appeals/Complaints (1)
  LH-3500.0200-300

  Health Insurance Market Appeals/Complaints

  LH-3500.0200-300
  
  Programs that are responsible for hearing appeals and resolving grievances that have been filed by people who have applied for health insurance through the Marketplace and disagree with a decision that has been made. Applicants have the right to appeal eligibility decisions, whether they can enroll in a Marketplace plan outside the regular open enrollment period, whether they are eligible for lower costs based on income, the amount of savings they are eligible for, whether they are eligible for Medicaid or CHIP, whether they are eligible for an exemption from the requirement to have health insurance, and whether the Marketplace made a timely determination regarding their eligibility after they applied. Employers that get a notice from the Marketplace stating they may be subject to the fee can file an appeal if they believe they offered coverage to an employee that is both affordable and meets minimum value standards. These appeals only relate to Marketplace determinations and do not affect issues related to the actual insurance plans available in a particular state.
• Medicare Information/Counseling (2)
  LH-3500.5000

  Medicare Information/Counseling

  LH-3500.5000
  
  Programs that offer information and guidance for older adults and people with disabilities regarding their health insurance options with the objective of empowering them to make informed choices. Included is information about benefits covered (and not covered); the payment process; the rights of beneficiaries; the process for eligibility determinations, coverage denials and appeals; consumer safeguards; and options for filling the gap in Medicare coverage (Medigap supplement insurance). Also available is information relating to an individual's eligibility for benefits and assistance with evaluating their options and enrolling in a Medicare plan (A, B, C, and/or D) that will best meet their needs. These programs also address coordination of benefits when beneficiaries have other types of health insurance in addition to Medicare (e.g. Medicaid, employer coverage or retiree insurance) and provide counseling and assistance regarding the subsidies that are available to low income beneficiaries enrolled in the Part D Prescription Drug Benefit (which help pay for Part D premiums and reduce the cost of prescriptions at the pharmacy) and the Medicare Savings Programs which help pay for Medicare out-of-pocket costs. They may also provide information about Medicaid and the linkages between the two programs, referrals to appropriate state and local agencies involved in the Medicaid program, information about other Medicare-related entities (such as peer review organizations, Medicare-approved prescription drug plans, Medicare administrative contractors), and assistance in completing related Medicare insurance forms.
• Retirement Benefits (1)
  NS-7000

  Retirement Benefits

  NS-7000
  
  Public programs administered by retirement disbursement authorities that make monthly cash payments to eligible workers and their eligible dependents following retirement. The amount of the monthly check is based on the worker's earnings and the length of time contributions were made to the retirement program.
• State Medicaid Waiver Programs (3)
  NL-5000.5000-800

  State Medicaid Waiver Programs

  NL-5000.5000-800
  
  Medicaid programs offered by states that have been authorized by the Secretary of the U.S. Department of Health and Human Services (HHS) to waive certain Medicaid statutory requirements giving them more flexibility in Medicaid program operation. Included are home and community care based (HCBC) waiver programs operated under Section 1915(c) of the Social Security Act that allow long-term care services to be delivered in community settings; managed care/freedom of choice waiver programs operated under Section 1915(b) of the Social Security Act which allow states to implement managed care delivery systems or otherwise limit individuals' choice of provider under Medicaid; and research and demonstration project waiver programs operated under Section 1115 of the Social Security Act to projects that test policy innovations likely to further the objectives of the Medicaid program. Each of the states has developed waivers to meet their needs; and while every state's waiver programs have their own unique characteristics, there may also be common threads.
• State/Local Health Insurance Information/Counseling (1)
  LH-3500.8000

  State/Local Health Insurance Information/Counseling

  LH-3500.8000
  
  Programs that offer information and guidance for people who do not qualify for Medicaid, do not have access to insurance provided by an employer or cannot afford privately purchased health insurance regarding their state and/or local government health insurance options (including insurance programs administered by the state or at the local level and public/private partnerships between state and/or local government entities and health insurance companies or other private organizations) with the objective of empowering them to make informed choices. Some programs may also help people who qualify with enrollment.
• Unemployment Insurance (1)
  NS-9000

  Unemployment Insurance

  NS-9000
  
  Programs that provide partial income replacement for a limited period of time for eligible individuals who become unemployed.