Insurance Exceptions.

If your child has had other insurance within the last six months, you will not qualify unless you meet one of the following exceptions:

  • Your family's annual health insurance cost (only premiums paid for medical, dental and vision are counted) is 10% or more of the family's gross income; or
  • You lost family coverage in the last six months due to layoff, job change, or your employer dropped coverage. (If you were laid off and already opted for coverage under COBRA, you cannot qualify for this exception); or
  • Your child is covered under the insurance of a non-custodial parent; and the insurance services can only be accessible in another state, or in a geographical area in WV that is considered to be non-accessible.

Note: You will need to submit copies of documents from your employer or insurance company to show changes in coverage or health care premium costs.

Q. I understand that the six month waiting period for a child who loses insurance is waived if the cost is more than 10% of the family's income. How is that calculated?

A. The total cost of the family coverage premium is used to determine whether it is more than 10%. For example, if a family of four earns $24,000 per year and their premiums for family coverage are $300 per month, the cost of the coverage is more than 10% of the family's income. ($24,000/12 months = $2,000 x 10% = $200 [your monthly premiums would need to be more than $200 to qualify for this exception])

Q. My health insurance for my kids costs over 10% of my gross income. I don't want to drop their coverage unless I'm sure they can get WVCHIP. What should I do?

A. You should make an appointment with your local DHHR office. You will need to bring proof of your family's income and the cost of the premium (usually on your paystub). Ask the worker to determine if your kids qualify for WVCHIP. You should not drop coverage unless the child's eligibility for WVCHIP has been determined. You will receive a denial notice and it will state you are being denied due to the fact you have health insurance. The application will then be held up to 45 days, pending proof of termination of other insurance coverage from applicant. When the original coverage ends, CHIP coverage will begin the 1st day of the following month.

Q. I am a divorced parent. My children receive medical coverage from their other parent. The insurance is not readily accepted in West Virginia. What should I do?

A. If your ex-spouse resides in another State or is a resident of West Virginia and your child is covered under your ex-spouse's insurance, you may apply to WVCHIP if the accessibility falls within the following guidelines.

Insurance is considered non-accessible when the following travel times are exceeded:

  •  Routine medical appointment - 30 minutes travel time from patient's residence to doctor's office
  •  Basic hospital service - 45 minutes travel time from patient's residence to hospital
  •  Other medical service - 60 minutes travel time from patient's residence to site.

When applying for WVCHIP, please provide the following information in order for DHHR to determine if you qualify for the non-accessible rule: Name of insurance company, policy number and phone number.

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