PARKLAND HEALTHfirst - Parkland Community Health Plan, Inc.
PARKLAND HEALTHfirst - Parkland Community Health Plan, Inc.
PARKLAND HEALTHfirst - Parkland Community Health Plan, Inc.
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<strong>Plan</strong> Changes<br />
Members are only allowed to make plan changes once a year. Members can ask to change health plans for<br />
exceptional reasons or good cause. HHSC must approve and will make the final decision on any request by<br />
members to change health plans.<br />
CHIP Perinatal Member Enrollment and Disenrollment<br />
Enrollment<br />
The mother of the CHIP Perinate has 15 calendar days from the time the enrollment packet is sent by the<br />
vendor to enroll in an MCO (where choice is available).<br />
Newborn Process<br />
60<br />
• All CHIP and CHIP Perinatal members in a household must be enrolled in the same MCO. Upon<br />
certification of CHIP Perinatal eligibility, children in the same household enrolled in the CHIP must be<br />
prospectively enrolled in the MCO providing the CHIP Perinatal coverage and disenrolled from their<br />
current MCO the first possible month. Co-payments, cost-sharing and enrollment fees still apply to<br />
children enrolled in CHIP.<br />
• In order to synchronize all CHIP and CHIP Perinatal members in a household, all members will remain<br />
in the MCO providing CHIP Perinatal coverage until the CHIP Perinate Newborn completes its 12-<br />
month eligibility. After the CHIP Perinate Newborn’s coverage period is completed, the child will be<br />
added to the existing CHIP case. The coverage period for the newly enrolled child will be the remaining<br />
period of coverage of the siblings already enrolled in the CHIP.<br />
<strong>Plan</strong> Changes<br />
• Once the mother of the CHIP Perinate picks an MCO, the CHIP Perinate must remain in this MCO until<br />
the end of the CHIP Perinatal continuous eligibility period.<br />
• If the mother of the CHIP Perinate does not pick an MCO within 15 calendar days of receiving the<br />
enrollment packet, the CHIP Perinate is defaulted into an MCO and the mother is notified of the plan<br />
choice. When this happens, the mother has 30 days to pick another MCO.<br />
• All CHIP and CHIP Perinatal members must remain in the same MCO until the end of the CHIP<br />
Perinatal continuous eligibility period. After the CHIP Perinate Newborn’s coverage period is<br />
completed, the child will be added to the existing CHIP case. The coverage period for the newly<br />
enrolled child will be the remaining period of coverage of the siblings already enrolled in CHIP. At the<br />
first CHIP renewal after the CHIP Perinatal eligibility ends, the family can pick a new MCO. Note:<br />
The switch of CHIP members from their MCO to the MCO providing the CHIP Perinatal coverage does<br />
not count as their one MCO change per year.<br />
• Members can ask to change MCOs for exceptional reasons or good cause.<br />
Disenrollment<br />
HHSC must approve and will make the final decision on any request for disenrollment of a member for<br />
cause.<br />
A provider cannot take retaliatory action against a member who is disenrolled from PCHP CHIP Perinate or<br />
PCHP CHIP Perinate Newborn.