The standard create product delivery process includes additional processing required to create a CHIP product delivery.
Selection of assistance unit members is a step specific to the Children's Health Insurance Program (CHIP). Participation in CHIP is optional for eligible individuals. During the eligibility determination process eligible household members are grouped into assistance units according to the household composition rules. Each assistance unit contains one or more eligible household members; however, an eligible household member only belongs to one assistance unit. The individuals within an assistance unit represent the household members that can exist together on a CHIP case. The selection process is required to confirm who is proceeding with CHIP coverage. A CHIP case is created for each assistance unit.
Once the assistance unit members have been selected, the premium processing rules determine the CHIP premium payable and the co-payment maximum limit for the assistance unit.
The premium payable is based on the household size, household income (expressed as a percentage of the federal poverty guideline) and the number of children applying for CHIP. Premium values and the frequency of premium payment are determined using Rate Tables.
A co-payment is a monetary contribution towards the cost of a service received under CHIP coverage. Enrollees in CHIP are required to pay co-payments, up to a maximum co-payment limit for a family within a specified period of time. The maximum co-payment limit for a family is calculated as a percentage of the family's gross countable income less the total amount payable in CHIP premiums by the family within a defined period of time. The time period to which the co-payment limit applies is based on the certification dates of the product delivery. In general, this will be 12 months.
The steps to select assistance unit members and view and accept their premium and co-payment details are repeated for each CHIP program selected from the Medical Assistance Eligibility Result.
When all CHIP assistance units have been selected and premiums and co-payment limits have been confirmed, a product delivery is created for each selected program using the standard create product delivery functionality within the product.