Can I change CHIP plans in Utah if my child’s needs change?
Is it possible to switch CHIP managed care plans if I find one that better fits my child’s healthcare needs?
Yes, it is possible to switch CHIP (Children’s Health Insurance Program) managed care plans in Utah if you find one that better fits your child’s healthcare needs. CHIP allows families to change their managed care plan during certain times of the year or under special circumstances. Here's what you need to know about switching CHIP plans.
1. When Can You Switch CHIP Managed Care Plans?
There are specific times and situations when you can switch your child’s CHIP managed care plan:
A. Open Enrollment Period
Every year, Utah offers an open enrollment period for CHIP, during which you can switch managed care plans for any reason. This is the most common time to change your plan and review your options.
B. Special Enrollment Period (SEP)
You may also qualify for a Special Enrollment Period (SEP) outside of open enrollment if you experience certain life changes, such as:
Moving to a new area where your current plan’s network doesn’t provide adequate coverage.
Changes in healthcare needs: If your child is diagnosed with a new medical condition or requires specialty care not available in your current plan.
Provider network changes: If your child’s doctor or specialist is no longer in-network, you may be eligible to switch plans.
2. How to Switch CHIP Managed Care Plans
If you determine that your child would benefit from a different managed care plan, follow these steps to make the switch:
A. Review Available Plans
Compare plans: Use the Utah Medicaid provider directory or CHIP plan comparison tools to review the available managed care plans and their benefits. Look for a plan that offers a network of healthcare providers that best meets your child’s needs, including specialists and hospitals.
Check coverage options: Ensure the plan covers the necessary services for your child, such as specialist care, therapies, mental health services, and any prescription medications they require.
B. Submit a Request to Change Plans
Once you’ve selected a new plan:
Online: Visit the Utah Medicaid website to submit a request to change your child’s managed care plan.
Phone: Call 1-866-435-7414 to speak with a representative and request the change over the phone.
In person: You can also visit your local Department of Workforce Services (DWS) office to submit a request in person.
C. Plan Change Approval
After submitting your request, the switch will typically be processed during the next coverage period. You will receive confirmation of your new plan and the date your child’s coverage will transition.
3. What to Consider When Switching Plans
When switching managed care plans, it’s important to consider the following:
Provider network: Ensure your child’s doctors, specialists, and healthcare providers are in-network with the new plan.
Prescription drug coverage: Verify that the new plan covers your child’s current medications.
Specialist access: If your child has special healthcare needs, check whether the plan offers access to necessary specialists and support services.
Out-of-pocket costs: Compare copayments, premiums (if applicable), and any out-of-pocket maximums to ensure the new plan fits your budget.
4. What Happens After You Switch Plans?
Once the plan change is approved:
Receive new plan details: You will receive information about your child’s new managed care plan, including a new benefits card and a list of in-network providers.
Update your providers: Inform your child’s doctors and specialists about the change in coverage and confirm that they accept the new plan.
Start using the new plan: Your child’s new coverage will begin on the effective date provided by Utah CHIP.
Key Takeaways:
You can switch your child’s CHIP managed care plan during the annual open enrollment period or qualify for a Special Enrollment Period (SEP) if you experience certain life changes.
To switch plans, review available options to ensure the new plan meets your child’s healthcare needs and submit a request online, by phone, or in person.
Consider factors like the provider network, prescription drug coverage, and specialist access when choosing a new plan.
For help switching CHIP managed care plans or reviewing your options, schedule an appointment with a Tsunami Advisor here: Schedule an Appointment.
