Community Resource Initiative has helpful information for clients, case managers, navigators and any other individuals who help those living with HIV access health insurance and drug payment assistance, listed below.
I’m very appreciative of everything you and your coworkers have done for us in such a short time. It is rare to come across someone in a program such as yours that cares. It’s unheard of to find that everyone does. Thank you.
Community Resource Initiative CHII Client
Did you know?
NOTE: CHII can pay monthly insurance premiums on behalf of eligible HDAP clients
- ConnectorCare plans
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- Eligible clients have an individual or family income that is less than or equal to 300% of the Federal Poverty Level
- Three plan levels: Types 1, 2, or 3
- Subsidized plans with Advanced Premium Tax Credits (APTCs)
- Plans have copays, but no deductible
- CHII can pay monthly premiums for ConnectorCare plans
- Qualified Health Plans (QHPs) also known as Health Connector Plans
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- Eligible clients have an individual or family income greater than 300% of the Federal Poverty Level
- Four “coin level” plans: Bronze, Silver, Gold, or Platinum
- Plans may be subsidized and include APTCs (depending on income)
- Plans have copays, and may have a deductible
- The Platinum level plans do not have deductibles and have the least amount of out-of-pocket expenses
- CHII can pay monthly premiums for Platinum-level plans for clients who do not qualify for ConnectorCare level plans
NOTE: Changes made during the Open Enrollment Period will take effect January 1, 2019
During the Medicare Open Enrollment Period, beneficiaries can:
- Do nothing and their Medicare coverage “should renew on the 1st of the year
- Enroll in, change, or leave their Medicare Part D plan (prescription drug coverage)
- Switch from Original Medicare (Parts A & B) to a Medicare Advantage plan (Part C, combining Parts A, B, & D)
- And should enroll in a Part D plan to maintain Medicare drug coverage
- Change from one Medicare Advantage plan to another
- Apply for a Medicare Supplemental (“Medigap”) plan, or change from one Medigap plan to another (members may enroll year-round; some limitations may apply)
A great way to enroll in a new plan is to go to Medicare’s website at www.medicare.gov. Clients can use this website to search and compare plans available in their area and create an account to enroll in a plan online. Another way to enroll in a new plan is to call Medicare at 1.800.633.4227.
Clients may want to contact The SHINE Program at 1.800.243.4636 (press option 3) to discuss their health insurance options before enrolling in a plan. SHINE (Serving the Health Insurance Needs of Everyone) is a state health insurance assistance program that provides free health insurance information and counseling assistance to Massachusetts residents with Medicare and their families.
NOTE: Medicare members enrolled in a Medicare Part D or Advantage plan should have received an “Annual Notice of Change” in September alerting them to any changes in their premium, copays, drug formulary, or pharmacy network.
HDAP’s CHII program can pay the monthly insurance premiums for Medicare Part D plans and Medicare Advantage plans that include prescription drug coverage for active HDAP clients.
CHII can help pay for the following:
- Private health insurance premiums
- Insurance premiums through the Massachusetts Health Connector
- MassHealth premiums
- Medicare Part B (for clients who do not have a deduction from their SSI check), C, and D premiums
- COBRA premiums
- Employee premium deductions
- Self-employed private insurance premiums
CHII enrollees should send their premium statements to HDAP/CHII every month. A client must be active in HDAP in order to receive CHII assistance for their insurance premiums.
Insurance policies are at risk of cancellation if CHII does not receive a monthly premium statement.
- All monthly premium bills, including those that show a $0 balance due, should be faxed to the CHII Program every month via fax number 617.502.1703.
- Urgent premium bills can be scanned and emailed via our secure email portal or directly to chii@crihealth.org for faster processing.
- Please contact the CHII Department with any questions
This process is especially important for CHII clients enrolled in coverage through the MA Health Connector, as these premiums sometimes change as a result of federal and state income verification checks or an expired request for information from the Health Connector.
When HDAP clients are approved for coverage, a letter is faxed to the client’s pharmacy that identifies the client’s health insurance and the maximum medication co-pay that can be billed to HDAP.
Failure to update HDAP when an enrolled client’s insurance coverage changes could impact a client’s ability to pick up medications due to a change in co-pay amount.
For clients who are also enrolled in our Comprehensive Health Insurance Initiative (CHII) program, failure to report a change in insurance could result in termination of coverage if a client’s insurance premium has increased and our CHII program has not been alerted. It could also result in a client owing a refund to our CHII program for money paid on an insurance plan that is no longer active.
Please fax insurance change information to HDAP as soon as possible via fax number 617.502.1703.
Comprehensive Health Insurance Initiative (CHII) FAQs
People who are HIV positive and applying to HDAP can request CHII in their HDAP application (as part of a new application or when recertifying). Clients who are already enrolled in HDAP can request assistance from CHII at any time during their enrollment in HDAP.
- If you are applying to CHII to cover the cost of your premium, please include a copy of your most recent health insurance premium (bill) with your HDAP/CHII application, or fax it directly to us at 617.502.1703.
- To send your premium bill via email, please use our secure email system.
- If you are applying for assistance for your employee premium deductions (current employer-based insurance), please contact HDAP staff for guidance.
Yes, please complete the HDAP section and be sure to fill out the CHII section of the application. Include a copy of your most recent health insurance premium bill.
No, HDAP/CHII is a payer of last resort. If you are eligible for other entitlement programs which pay for medications (such as MassHealth or Medicare Part D), you must apply to and enroll in these programs.
If you are applying for assistance with your employee premium deductions (current employer-based insurance), please contact HDAP Staff for guidance.
Contact Community Resource Initiative’s BRIDGE Team (Benefits Resources Infectious Disease Guidance and Engagement) for assistance filling out the COBRA application. If you are already enrolled in COBRA, send CHII a copy of the most recent COBRA premium bill. CHII will then review the request and if you are eligible, we will make the payment to the insurance provider on your behalf.
CHII can help pay for the following:
- Private health insurance premiums
- Insurance premiums through the Massachusetts Health Connector
- MassHealth premiums
- Medicare Part B (for clients who do not have a deduction from their SSI check), C, and D premiums
- COBRA premiums
- Employee premium deductions
- Self-employed private insurance premiums
CHII enrollees should send their premium statements to HDAP/CHII every month. A client must be active in HDAP in order to receive CHII assistance for their insurance premiums.