PARKLAND HEALTHfirst - Parkland Community Health Plan, Inc.

CHIP Member Enrollment and Disenrollment
Enrollment Application
Parents and guardians can apply telephonically for CHIP coverage by contacting CHIP at 1-800-647-6558.
Applicants can ask for a blank form or CHIP will print completed applications based on phone information and
mail to the requesting party for signature and return. Applicants can download and complete application forms
from the internet at www.chipmedicaid.com. Once enrolled, the CHIP eligibility remains continuous for 12
months. Eligibility determination is the responsibility of the HHSC Administrative Services Contractor.
Enrollment Process
Eligibility determination notices are sent to families determined eligible based on completed applications. The
enrollment packet mailed to families contains:
• Explanation of CHIP benefits
• Comparison table showing value-added services by health plan
• A place to indicate a child with special health care needs
• A place to indicate whether a medical support order is applicable
• How to pick a health plan, primary care provider , and the choice to pick a specialist as Primary Care
Provider
• Provider directories
• Cost-sharing information specific to the income level of the family and payment coupon book for families
with net income over 150% Federal Poverty Level
• Simple form to track cost-sharing expenses relative to caps
• Information concerning the grievances and appeals process
Reminder notices are sent 14 days after enrollment packages are mailed to members. Concurrent notice is sent
to the Community Based Organization (CBO) when there is a record of past involvement with the family. A
follow-up letter is mailed 14 days after the reminder notices. Families who are unresponsive to the two followup
attempts are timed out after 60 days.
Post-enrollment letters are sent as temporary evidence of coverage, pending receipt of the health plan ID card.
Enrollment letters will contain the following information:
• Member ID numbers
• First date of coverage
• Health plan and Primary Care Provider sections
• Applicable co-payments
Re-Enrollment
At the beginning of the tenth month of coverage, the Administrative Services Contractor will send a notice to
the family outlining the next steps for renewal for continuation of coverage. The Administrative Services
Contractor will also send a notice to the Health Plan regarding its members and to a community based outreach
organization providing follow-up assistance in the members’ areas. To promote continuity of care for children
eligible for re-enrollment, the HMO can ease re-enrollment through reminders to members and other
appropriate means. Failure of the family to respond to the Administrative Services Contractor’s renewal notices
will result in disenrollment from the plan and from CHIP.
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