Issues in Developing Programs for Uninsured Children: A Resource Book for States. B. Procedures for Collecting Premiums

03/02/1998

Six of the nine children's insurance programs examined in this report collect monthly premiums: Florida, Massachusetts, Minnesota, New York, Pennsylvania, and Tennessee. Each of these programs determines premium levels based on a sliding scale. The premium sliding scales for these six states are shown below in Tables 8 through 13. These programs collect and process payments through a central office.

  • The Florida Healthy Kids Program requires parents to mail monthly premiums to the program office.
  • In Minnesota, monthly premiums must be either sent by mail or paid in person at the state MinnesotaCare office. Minnesota is currently investigating other options to permit parents to pay premiums by automatic payroll and checking withdrawal, assigning tax returns, and/or credit card payments.

In addition to these six programs, the Colorado Children's Health Plan currently collects a $25 annual enrollment fee due at the point of application. Pennsylvania, does not collect premiums, but rather requires the contracted health plans to collect premiums.

Table 8: Florida Healthy Kids Corporation Premium Sliding Scale*

County VOLUSIA DADE SANTA ROSA HARDEE
Free Lunch $10 $10 $5 $5
Reduced Lunch $25 $20 $15 $13
Not on Lunch Program $48 $51 $53 $49

*A sliding scale of costs is developed by each local project and submitted to Healthy Kids for approval. A family's eligibility for the National School Lunch Program confirms eligibility for a reduced premium. This table shows examples of premium sliding scales for four local projects.

Table 9: Massachusetts Children’s Medical Security Plan Premium Sliding Scale

Monthly Premium $0 $10.50 per child up to family maximum of $31.50 Full premium
$52.50 per child
Percentage of Poverty 0-200% 201-400% +400%

Table 10: MinnesotaCare Premium Sliding Scale*

Percent of Poverty Premium Contribution by Number Covered
1 2 3
0-62% $4 $8 $12
62-89% $5-7 $10-14 $15-21
89-115% $9-12 $18-23 $28-35
115-142% $16-19 $32-39 $48-58
142-168% $24-28 $49-57 $73-85
168-195% $36-41 $73-83 $109-124
195-221% $52-58 $103-116 $155-174
221-248% $74-82 $147-163 $221-245
248-275% $98-128 $196-255 $294-383

*MinnesotaCare enrollees pay a monthly premium based on family size and income. This table consolidates a more extensive premium sliding scale for a family of fourso that it may be compared to others based on the %FPL. The full premium is $128 per person per month.

Table 11: New York Child Health Plus Premium Sliding Scale

Monthly Premium $0 $9 per child up to family maximum of $36 $13 per child up to family maximum of $52 Full premium:
$58-99 per member *

 

Percentage of Poverty 0-120% 120-159% 160-222% +222%

*The full premium for NY Child Health Plus depends on the insurance company and the location. For example, insurance companies in NY City have the highest premiums.

Table 12: Pennsylvania CHIP Premium Sliding Scale*

GRANTEE AND REGION FREE SUBSIDIZED STATE SHARE SUBSIDIZED
Central
CBC/KHPC
CBC/KHPC
KHPC & USHC
$63.00
$46.44
$52.23
$81.90
$60.37
$67.90
$40.95
$30.19
$33.95
Northeast
BCNEPA
First Priority Health
$59.14
$59.14
$76.88
$76.88
$38.44
$38.44
Southeast
USHC & KHPE
$52.23 $67.90 $33.95
Western
KHPW
USHC & KHPW
BCWPA
$64.25
$51.77
$62.50
$83.53
$67.30
$81.25
$41.77
$33.65
$40.63

*Chart from CHIP annual Report for contract year July 1, 1995 through June 30, 1996. CHIP pays 50% of the subsidized rates. BCNEPA-Blue Cross Northeast PA (Caring Foundation of Northeastern PA). BCWPA-Blue Cross Western PA (Western PA Caring Foundation). CBC-Capital Blue Cross (Caring Foundation of Central PA). First Priority Health-Caring Foundation of Northeastern PA. KHPC-Keystone Health Plan Central (Caring Foundation of Central PA). KHPE-Ketystone Health Plan East (Independence Blue Cross & PA Blue Shield). KHPW-Keystone Health Plan West (Western PA Caring Foundation). USHC-U.S. Healthcare.

Table 13: TennCare Premium Sliding Scale

Family Monthly Premium $0 $24.50 $32.25 $47.50 $70.50 $183.50 $200.75
Percentage of Poverty 0-100% 101-119% 120-139% 140-169% 170-199% 200-209% 210-219%