PROVIDER MANUAL - Sendero Health Plans

Sendero Provider Manual Page 137 of 184
A CHIP Perinatal newborn whose birthdate on or after September 1, 2010, and who lives in a family
with an income at or below 185% of the FPL will be deemed eligible for Medicaid and will receive 12
months of continuous Medicaid coverage (beginning on the date of birth).
A CHIP Perinatal newborn will continue to receive coverage through CHIP Perinatal as a “CHIP
Perinatal Newborn” if: (1) born before September 1, 2010, or (2) if born on or after September 1, 2010,
to a family with an income above 185% to 200% FPL.
A CHIP Perinatal Newborn is eligible for 12 months continuous CHIP enrollment, beginning with the
month of enrollment as a CHIP Perinatal (month of enrollment as an unborn child plus 11 months). A
CHIP Perinatal Newborn will maintain coverage in his or her CHIP Perinatal health plan.
If the mother of the CHIP Perinatal newborn lives in an area with more than one CHIP/CHIP Perinatal
MCO, and does not select an MCO within 15 calendar days of receiving the enrollment packet, the
CHIP Perinatal newborn is defaulted into an MCO and the mother is notified of the plan choice. When
this occurs, the mother has 90 days to select another MCO.
When a member of a household enrolls in the CHIP Perinatal, all traditional CHIP members in the
household will be disenrolled from their current health plans and prospectively enrolled in the CHIP
Perinatal member’s health plan. All members of the household must remain in the same health plan until
the later of (1) the end of the CHIP Perinatal member’s enrollment period, (2) the end of the traditional
CHIP Program members’ enrollment period. In the 10th month of the CHIP Perinatal Newborn’s
coverage, the family will receive a CHIP renewal form. The family must complete and submit the
renewal form, which will be pre-populated to include the CHIP Perinatal Newborn’s and the CHIP
Program members’ information. Once the child’s CHIP Perinatal coverage expires, the child will be
added to his or her siblings’ existing CHIP program case.
CP 1.4 Span of Eligibility (Members’ Right to Change Health Plans) – CHIP
Perinatal
CHIP Perinatal Program Members may request to change health plans under the following circumstances:
o for any reason within 90 days of enrollment in the CHIP Perinatal; and
o for cause at any time.
Requests are forwarded to HHSC, the Administrative Services Contractor, who makes the final determination.
For more information, contact the CHIP Helpline at 1-800-647-6558.
CP 1.5 Disenrollment from Health Plan
Disenrollment may occur if a Member loses CHIP Perinatal eligibility. A CHIP Perinatal Member can lose
eligibility for the following reasons:
Change in health insurance status, i.e., a Member enrolls in an employer sponsored health plan
Sendero Customer Services 1-855-526-7388 Network Management 1-855-895-0475
Health Services Dept.: 1-855-297-9191 (FAX 1-512-275-2862)