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For families who cannot pay for private health insurance

Purpose: To give uninsured families access to affordable health coverage. For families who cannot pay for private health insurance Eligibility is based on family size and income Assets are not counted. Awareness of NJ FamilyCare. More than 519,000 children are currently enrolled

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For families who cannot pay for private health insurance

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  1. Purpose: To give uninsured families access to affordable health coverage. • For families who cannot pay for private health insurance • Eligibility is based on family size and income • Assets are not counted

  2. Awareness of NJ FamilyCare • More than 519,000 children are currently enrolled • At least 90,000 more children in NJ may be eligible • Almost half the families with eligible uninsured children do not believe NJ FamilyCare applies to them

  3. To enroll another 50,000 children by July 2007. Support the outreach to children by providing health insurance to their parents. NJ FamilyCare Enrollment Goals (July 2006)

  4. Family Health Care Coverage Act 2005 • As of September 1, 2005, coverage became available to uninsured low-income parents/guardians with children who are 18 or younger. • Income must be at or below 115% of the Federal poverty level (FPL). This will increase to 133% in September 2007.

  5. Parent /Guardian Income Guidelines • September 1, 2006: NJ FamilyCare offers coverage to certain low-income parents at or below 115% of the federal poverty level:

  6. Eligibility At A Glance • 18 years old or younger, or a parent of a child 18 or younger • Within the income guidelines for the program – assets are not counted • A New Jersey resident • U.S. citizens or qualified immigrants whose documents allow them to live here permanently, regardless of their date of entry into the country • Uninsured for at least three months prior to application*Exceptions apply* (see next slide) • NJ FamilyCare is not meant to replace existing coverage but to provide insurance for those who actually are uninsured

  7. *Exceptions to 3 Month Rule • If family is 133% of FPL or below • Lost job through no fault of their own • COBRA has expired • 200% of FPL or below can apply with COBRA or private insurance

  8. Year 2006 Income Guidelines*

  9. The A-B-C-Ds of NJ FamilyCare

  10. Income at or below 133% FPL: $26,600 for a family of four No premiums or co-pays Comprehensive package of medical benefits Immediate enrollment covered by fee-for-service providers until the HMO begins Retroactive coverage is available, if eligible Plan A (Children)

  11. Income above 133% up to 150% FPL: $30,000 for a family of four No premiums or co-pays, benefits like Plan A A family must select an HMO before they can be enrolled Plan B (Children)

  12. Income above 150% up to 200% FPL: $40,000 for a family of four Premiums of $18.00 per month Co-pays for certain services, but not to exceed $10 Same benefits as Plan B A family must select an HMO before they can be enrolled Plan C (Children)

  13. Income above 200% up to 350% FPL: $70,000 for a family of four Mirrors commercial insurance Premiums are either $36, $72, or $120.50 per month depending on income Co-pays won’t exceed $35 Only preventative dental care until age 12 Not enrolled until they select their HMO Plan D (Children)

  14. Income at or below 115% FPL: $23,000 for a family of four Mirrors commercial insurance No premiums or co-pays No dental Plan D (Parents)

  15. Plan A Covered from the first day of the month application is filed Automatically enrolled in an HMO if one is not chosen Plan B No coverage until family is enrolled in an HMO Plans C & D No coverage until premium is paid & family is enrolled in an HMO When Does Coverage Begin?

  16. What Services Are Covered? • Physician Visits • Emergency Care • Preventative Services • Vision & Hearing Screenings • X-rays • Dental (in most cases) • Prescriptions • Mental Health Services • Hospitalizations & more…

  17. PresumptiveEligibility Uninsured children needing immediate care from a hospital or Federally Qualified Health Center can apply for Presumptive Eligibility *(PE). Immigrant children must have resided in the US for at least 5 years to apply for PE (not for NJ FamilyCare). A copy of the completed PE application will be used to apply for full NJ FamilyCare coverage. If the family has an application pending with NJ FamilyCare at the time they apply for PE, write: ‘NJ FamilyCare application pending’ on the PE application. *See next slide for further explanation of Presumptive Eligibility

  18. PE provides temporary health insurance for uninsured children who need immediate treatment. Hospitals and Federally Qualified Health Centers (FQHCs) complete the application based on the initial determination that the child appears eligible for NJ FamilyCare. No documentation is required for PE. Families will receive a letter requesting documentation to complete enrollment into NJ FamilyCare. For Presumptive Eligibility sites in your area, please call NJ FamilyCare at 1-800-701-0710. What is Presumptive Eligibility (PE)?

  19. PE application is black and white, the NJ FamilyCare application is multicolored PE application asks for date of entry of any non-citizen requesting coverage. PE application requests PE provider #, and where application was sent in box where NJ FamilyCare application asks for enrollment site #. NJ FamilyCare vs. PE Application

  20. The Application

  21. Section 1- Household We must have accurate information to contact the family. • List all Parent/Guardians and children under the age of 21 living in the household. • First person listed on application is considered “Head of Household.” • Social Security number: Must provide SSN for everyone applying • Parents, Step-Parents, or Guardians (if no parent resides in the household) & Children under 21 are the only people listed in this section.

  22. Section 2- Income Information • Report Income for every job & each person • Include working children ages 16-20 • Include Under-the-Table jobs • Employee Verification Letter • Zero Income requires a Letter of Support

  23. Section 3 – HMO Selection • Applicant should find out what NJ FamilyCare HMOs are available in their county. An HMO flyer is included in each application kit. • They can call their current doctor/hospital to see if they participate with one of those HMOs. • Call 1-800-701-0710 for assistance. • If they choose any HMO in their county, and do not select a doctor, a doctor will be assigned to them.

  24. Required Documents • Proof of Income: • 1 pay stub for each job for the most recent month available, award letters or some proof of each kind of income received. • Proof of citizenship/identity or qualified immigrant status • Proof of other Insurance (if applicable): • A copy of the front and back of the insurance card. • Or letter stating the insurance ended.

  25. General Application Concerns • Fill in every box • Print Clearly • Fill in your Enrollment Site Number: DFD576 • Place your name/initials under the ES# box • Review the application with the family • Make sure the family signs the application

  26. Use the Literature Order Form to request more applications and other NJ FamilyCare materials Remember to include you Enrollment Site Number on each request! How to order more applications

  27. Assess families health insurance status Assist families with completing application when requested Monitor status of application Provide follow-up if needed Report number of applications completed monthly to FWC Maintain supply of applications Family Worker Responsibilities

  28. Provide NJ FamilyCare training to new Family Workers Provide on-going technical assistance for NJ FamilyCare to Family Workers Report number of NJ FamilyCare applications completed on a quarterly basis to DFD FWC Responsibilities

  29. Follow-Up • Allow 2-3 months for an eligibility decision • Explain usage of the NJFC call center (1-800-701-0710) • Explain Yearly Renewal process • Encourage families to report changes in household, income, address, etc.

  30. You can help families fill out the NJ FamilyCare application online at: www.njfamilycare.org www.njhelps.org The online application requires the same documentation as the paper application A confirmation letter will be sent to the applicant requesting the necessary documentation. Applying Online

  31. NJ FamilyCare Regional Offices1.866.411.7782 • Hamilton Regional Office, Yvette Holmes-Cannon, Supervisor 240 Princeton Ave, Suite 105 Hamilton, NJ 08619 yvette.holmescannon@acs-inc.com Customer Main Phone Line- (609) 631-2620, Ext. 6705 Fax - 609-631-6303 Covers – Burlington, Mercer, Monmouth, Ocean • New Brunswick Regional Office, Yvette Holmes-Cannon Supervisor 303 George St. – Plaza 1, Suite 410 New Brunswick, NJ 08901 Customer Main Line - (866) 411-7782 Option 4 Fax - (732) 247-2967 Covers – Middlesex, Hunterdon

  32. NJ FamilyCare Regional Offices1.866.411.7782 • Camden Regional Office, Mary Francis Monico, Supervisor 519 Federal Street – Suite 209 Camden, NJ 08103 mary.monico@acs-inc.com Customer Main Phone Line – (866) 411-7782 Option 3 Fax - (609) 631-6324 Covers – Atlantic, Camden, Cape May, Cumberland, Gloucester, Salem • Paterson Regional Office, Cynthia M. Slade, Supervisor 100 Hamilton Plaza, Suite 400 Paterson, NJ 07505 cynthia.slade@acs-inc.com Customer Main Phone Line – (866) 411-7782 Option 2 Fax - (609) 631-6450 Covers – Bergen, Morris, Passaic, Sussex, Warren

  33. Newark Regional Office, Jacqueline Fisher, Supervisor 60 Park Place Suite 605 - 6th floor Newark, NJ 07102 jacqueline.fisher@acs-inc.com Customer Main Phone Line - (866) 411-7782 Option 1 Fax - (609) 689-6853 Covers – Essex, Hudson, Somerset, Union NJ FamilyCare Regional Offices1.866.411.7782

  34. If you have any questions or concerns, contact your Family Worker Coordinator, who will then contact the Office of NJ FamilyCare.

  35. Your Refresher Training is Complete! Thank You! www.njfamilycare.org (800) 701-0710

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