Notice of Changes to the WV CHIP Program
Effective: July 1, 2002
The following changes have been made to the West Virginia Children's Health Insurance Program (WV CHIP), and are effective on July 1, 2002:
► New Billing Time Limit for Filing Medical Claims
As of July 1, 2002, all CHIP medical claims must be filed within six months of the date of service. Claims not submitted within this period will not be paid, and WV CHIP will not be responsible for payment.
► Benefit Limit Amounts: Annual and Lifetime Limits
An annual and lifetime cap will be placed on total claims amounts for members with WV CHIP coverage. As of July 1, 2002, an annual limit of $200,000, and a lifetime limit of $1,000,000 has been placed on benefits, as passed by the CHIP Board of Directors. These caps will include all medical, dental and vision services combined. A letter will be sent to those members who have reached 75% of the maximum limitation to alert them in advance of reaching the cap.
► New Prescription Drug Co-Payments
Members will pay no co-payment ($0) for generic prescription drugs, a $10 co-payment for brand name prescription drugs listed on the new formulary, and $15 co-payment for brand name prescription drugs not listed on the new formulary.
Click here to view the new prescription drug
formulary.
► New Pharmacy Benefits Manager
Express Scripts, Inc. will become the new Pharmacy Benefits Manager (PBM). For questions relating to services, they can be reached at 1-877-256-4689 for member services, or at 1-800-824-0898 for provider services.
► New Pre-certification Procedure for Allergy Testing
Allergy testing must be pre-certified and approved prior to date of procedure. Acordia National can be contacted at 1-800-356-2392 to pre-certify allergy testing.
► New Nurseline
Members can call to get answers to medical questions from a registered nurse and medical information service, toll-free: 1-877-294-7342. Staffed by WVU Healthline 24 hours a day.
WV CHIP members will receive: Nurse triage, Health education, Referral of health care resources, Health-related literature mailed upon request, and Courtesy calls to callers whose symptoms were assessed under the category of urgent within 24 hours.
► New WV CHIP Member Cards
New cards are being sent out to all current WV CHIP members. The cards will include the WV CHIP logo, and also the logo's of the Public Employees Insurance Agency (PEIA), Express Scripts, and participating health networks. One card will be used for both medical and prescription drug needs. Since prescription drug co-payments will apply to everyone on the program, the cards will differ for members by stating "Drug Copays Only" for those members who currently have no co-payments, and "Copays Apply" for those members who currently have co-payments.
For More Information:
Call the WV CHIP Helpline toll-free at 1-877-WVA-CHIP (1-877-982-2447) which is available Monday through Friday, 8 am to 8 pm.
Services include:
* Answering questions concerning WV CHIP,
* Helping applicants complete application over the phone,
* Have Spanish translation capability, and
* TTY/TDD phone line for the hearing impaired.
You can also reach the main office of WV CHIP by calling 304/558-2732.
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