Not all employers have the same capacity to provide for their employees’
needs. Most employers want to help their low-income employees be able to provide the kind of health insurance that their
families need, but, for a variety of reasons,
those employers are unable to provide that
coverage directly.
In those cases, employers need to be
aware of new programs that have become
available in recent years that are designed
to provide coverage for families, regardless of income level. There are options,
such as Pennsylvania’s Children’s Health
Insurance Program (CHIP) that employers
can educate their employees about to help
employees provide for the needs of their
families.
“A lot of times, people think that a program like CHIP is just for people on
Medicaid, but that’s not the case,” says
John Lovelace, the vice president of
Medicaid and CHIP services for the UPMC
Insurance Services Division and UPMC
Health Plan. “In Pennsylvania, CHIP is
available to most uninsured children and
teens up to the age of 19, regardless of
income, except for those who are eligible
for Medicaid (known as ‘Medical Assistance’ in Pennsylvania).”
Smart Business talked with Lovelace
about CHIP and other ways to find health
benefits for low-income employees.
What factors keep low-income workers from
finding family health insurance?
First, low-wage workers are more likely
than other workers to be employed in
industries that do not offer benefits. They
are also more likely to be part-time, or seasonal workers, who also do not have benefits. Studies show that there is a decline in
employer-sponsored insurance, which is
highest among poor and near-poor employees, those who work in small businesses
and those who are under age 35. A majority
of employees who are uninsured have no
access to employer-sponsored insurance
either because no one in their family works
for a business that sponsors health benefits,
or they are not eligible at work for health
benefits.
Do low-income workers have benefit options
when an employer-sponsored health benefits
plan is not available to them?
Yes. Many states provide options in such
cases. For instance, in Pennsylvania, workers may be eligible for the Pennsylvania
adultBasic program, which, like CHIP, is
offered through the Pennsylvania Insurance
Department. To be eligible, an individual
must not have other coverage. Premiums
are subsidized by the state. However, there
are more eligible workers than slots on the
program, so an applicant may be placed on
a waiting list for coverage.
What is CHIP?
CHIP was designed to provide insurance
for all uninsured children and teens that are
not eligible for enrollment in Medical
Assistance programs. This program was
established in 1992, and has grown steadily
since that time. Beginning in 2007, following the state’s ‘Cover All Kids’ initiative, the
program’s reach has been greatly expanded. Now, there are no upper income limitations on membership. CHIP is administered by private health insurance companies that
are licensed and regulated by the
Pennsylvania Insurance Department and
are contracted by the state to offer CHIP.
Is CHIP designed exclusively for low-income
families?
No family makes too much money for
CHIP. There is no upper income limit. If
your company does not provide coverage
for your employees’ families, you can help
by offering education about CHIP, as that
could provide the coverage their children
and teens require. For example, if a family of
four makes up to $42,400 a year, the family
is eligible for what is known as free CHIP.
There are no premiums and no co-payments
with free CHIP. A variety of low-cost CHIP
programs are available for a family of four
that makes up to $63,600. Depending on
income level, premiums can range from
about $35 a month to less than $60. If a family of four makes more than $63,600, they
are still eligible to purchase CHIP at cost.
Monthly premiums for at-cost CHIP would
cost about $143. Children who are enrolled
in free CHIP do not have to pay any co-payments for any services. With low-cost and
at-cost CHIP, there are co-payments for
some services, but there are never any co-payment charges for preventive services.
What obstacles keep low-income employees
from enrolling in programs such as CHIP?
First, many people are simply unaware of
the program’s existence because they have
never been exposed to it, or they don’t
think they qualify. They may think it’s a
‘welfare program,’ or a program that they
can’t afford. Or, they may even think that
their children wouldn’t need it because
they are young and healthy. That’s where
an employer can help. By making information on these programs available to their
employees, or by showing them where
they can get more information, employers
can help lead their employees to a program
that fits their needs.
JOHN LOVELACE is the vice president of Medicaid and CHIP services for the UPMC Insurance Services Division and UPMC Health
Plan. Reach him at (412) 454-5269 or [email protected].
