Title 16
18000 Delaware Healthy Children Program
Families with eligible children are required to pay a premium in order to receive coverage. The premium is per family per month regardless of the number of eligible children in the family. The monthly premium will vary according to countable family income as follows:
Countable Family Income |
Premium |
> 100% FPL < or = 133% FPL |
$10 |
>133% FPL < or = 166% FPL |
$15 |
> 166% FPL < or = 200% FPL |
$25 |
Payments that are less than one month’s premium will not be accepted.
18700.1 Initial Premium
Coverage begins the first of the month following payment of the initial premium. Payments for the initial premium will be accepted through a monthly cut-off date known as the authorization date. The authorization date is set by the automated eligibility system. If payment of the initial premium is received by the authorization date, coverage under DHCP will be effective the following month.
18700.2 Premiums to Continue Coverage
A monthly premium notice will be sent to the family. The premium is due by the 20th of the month for the next month’s coverage. Premium payments for ongoing coverage will be accepted through the last day of the month.
18700.3 Advance Payment of Premiums
Families will be able to pay in advance and purchase up to one year’s coverage. The following incentive is offered for advance payments:
Pay 3 months – get 1 premium free month
Pay 6 months – get 2 premium free months
Pay 9 months – get 3 premium free months
The advance premium payments for coverage may extend beyond the scheduled eligibility redetermination. If the child is determined to be ineligible, the advance premium payments will be refunded to the family.
18700.4 Refunds of Premiums
When a child is determined ineligible for DHCP, any advance premium payments will be refunded to the family. Premium payments for a current month of eligibility will not be refunded.
18700.5 Cancellation of Coverage for Nonpayment of Premiums
Coverage will be cancelled when the family is in arrears for two premium payments. The coverage will end the last day of the month when the second payment is due. A notice of cancellation will be sent to the family advising the family to report any change in circumstances, such as a decrease in income, that may result in eligibility for Medicaid. If one premium payment is received by the last day of the cancellation month, coverage will be reinstated.
Families who lose coverage for nonpayment of premiums will have received two unpaid months of coverage. Families who are cancelled for nonpayment of premiums may reenroll at any time without penalty, with the reenrollment period starting with the first month for which the premium paid.
Eligibility redeterminations will be processed without regard to the families' enrollment status.
18700.6 Good Cause for Nonpayment of Premiums
Good cause for nonpayment of premiums will be determined by DSS on a case-by-case basis.
