CHAND

Are you eligible for CHAND coverage?

You are eligible for CHAND if you qualify as a traditional, HIPAA,  TAARA, or Age 65 and Over or Disabled applicant. The requirements for each of these applications are shown below.

Traditional applicant
Traditional applicants are eligible for coverage after meeting all of the following conditions:

  1. You currently reside in the state of North Dakota.
  2. You have physically resided in the state of North Dakota for at least 183 days.
  3. You have written evidence from at least one carrier that within 180 days, you have been;
    1. denied health care insurance coverage for health reasons;
    2. offered coverage which substantially restricts benefits for specific conditions;
    3. offered an insurance rate exceeding the CHAND rate; or
    4. you have written evidence from a medical professional of the existence of a qualifying condition.
  4. You are not eligible for health benefits under the state of North Dakota’s medical assistance program.
  5. You are not an inmate or a resident of a public institution.
  6. Your health insurance premiums are not paid for or reimbursed under any government sponsored program, government agency, health care provider, nonprofit charitable organization or your employer.
  7. You have not been insured through CHAND during the last 12 months.

Coverage will terminate if:

  1. The individual becomes eligible for health benefits under the state of North Dakota’s medical assistance program.
  2. CHAND has paid one million dollars on behalf of the individual.
  3. The individual becomes an inmate or a resident of a public institution.
  4. The individual’s health insurance premium is paid for or reimbursed under any government sponsored program, government agency, health care provider, nonprofit charitable organization or employer.
  5. The individual has requested termination of coverage.
  6. The individual has failed to pay the required premium within the 31-day grace period.
  7. The individual has physically resided outside the state for more than 182 days of each calendar year unless the individual has been absent from the state for a verifiable medical reason as determined by the Board.
  8. The individual fails to respond to an inquiry from the Lead Carrier concerning his/her eligibility or place of residence within 30 days.

Note:  If an individual’s coverage is cancelled, he/she may enroll again only after a minimum of 12 months has lapsed since termination.

Waiting Periods:

During the first 180 consecutive days of your CHAND coverage, benefits will not be provided for services, supplies or charges for the care or treatment of any pre-existing condition that was diagnosed or treated during the  180 days immediately preceding  the signature date of the application. During the first 270 days of your coverage, benefits will not be provided for maternity services. However, if you qualify for coverage due to a catastrophic condition or major illness and are pregnant at the time of application, you will be eligible for maternity benefits following a waiting period of 180 days of continuous coverage.

Waiting periods do not apply to subscribers receiving nonelective treatment or procedures who have lost dependent status under a parent’s or guardian’s policy (which has been effect for 12 months immediately preceding the effective date of coverage). Also, no waiting periods apply for subscribers requiring nonelective treatment or procedures for a congenital or genetic disease.

Qualifying Previous Coverage:

The waiting period of 180 consecutive days of coverage under this benefit plan may be reduced by days of membership under qualifying previous coverage, if continuous to a date within 63 days prior to your effective date under this benefit plan.

When days of membership under qualifying previous coverage are applied to the waiting period, benefits for covered services will be available to the extent provided by the coverage in force at the time covered services are received by you. If no coverage is available for a specific service under the qualifying previous coverage, the waiting period will apply to the specific service.

HIPAA applicant
Applicants qualify under federal law. You are eligible for coverage if you meet all of the following conditions:

  1. You currently reside in the state of North Dakota; and
  2. You have met the following federally defined eligibility guidelines under the Health Insurance Portability and Accountability Act of 1996 (HIPAA):
    1. You have had 18 months of qualifying previous coverage, the most recent of which is coverage under a group health benefit plan, government plan, church plan, or health insurance coverage offered in connection with any of these plans; and
    2. You have applied for coverage within 63 days of the termination of the qualifying previous coverage; and
    3. You are not eligible for coverage under a group health benefit plan, Medicare or Medicaid; and
    4. You do not have any other health insurance coverage; and
    5. You have not had the most recent qualifying previous coverage terminated for nonpayment of premiums or fraud; and
    6. You have declined continuation coverage offered by your employer; or you have elected continuation coverage through your employer and have exhausted the coverage extension.
  3. You are not eligible for health benefits under the state of North Dakota’s medical assistance program.
  4. Your health insurance premiums are not paid for or reimbursed under any government-sponsored program, government agency, health care provider, nonprofit charitable organization or your employer.

Termination

Coverage will terminate if:

  1. The individual becomes eligible for health benefits under the state of North Dakota’s medical assistance program.
  2. CHAND has paid out one million dollars on behalf of the individual.
  3. The individual’s health insurance premium are paid for or reimbursed under any government sponsored program, government agency, health care provider, nonprofit charitable organization or employer.
  4. The individual has requested termination of coverage.
  5. The individual has failed to pay the required premium within the 31-day grace period.
  6. The individual has physically resided outside the state for more than 182 days of each calendar year unless the individual has been absent from the state for a verifiable medical reason as determined by the Board.
  7. The individual fails to respond to an inquiry from the Lead Carrier concerning his/her eligibility or place of residence within 30 days.

Waiting Period

Waiting periods do not apply to individuals that are eligible for CHAND as a HIPAA applicant.

TAARA applicant
Applicants are certified federally. You are eligible for coverage if you meet all of the following conditions:

  1. You currently reside in the state of North Dakota.
  2. You have been certified as eligible for federal trade assistance and health insurance tax credit (TAA) or for pension benefit guarantee corporation assistance (PBGC) as provided by the federal Trade Adjustment Assistance Reform Act of 2002 (TAARA).
  3. You have had three or more months of previous health insurance coverage.
  4. You have applied for coverage within 63 days of termination of qualifying previous coverage.
  5. You are not an inmate or a resident of a public institution.
  6. You are not enrolled for health benefits under the state of North Dakota’s medical assistance program.
  7. You have not been insured through CHAND during the last 12 months.

You certify that (you must fall within one of the below options):

  1. You do not have health insurance coverage through any of the following:
    1. An employer plan that provides for employer contribution of 50 percent or more of the cost of coverage of eligible dependents or the coverage is in lieu of an employer’s cash or other benefit under a cafeteria plan;
    2. North Dakota’s children’s health insurance program (Healthy Steps);
    3. a government plan;
    4. Chapter 55 or United States Code title 10 relating to armed forces medical and dental care; or
    5. Medicare.
  2. You are eligible for health insurance coverage through one of the following but you are electing to obtain coverage as a TAA/PBGC qualified individual:
    1. continuation coverage;
    2. an employer plan in which the employer contribution is less than 50 percent; or
    3. an individual marketplace plan, including continuation or guaranteed issue.

Termination

Coverage will terminate if:

  1. The individual becomes eligible for health benefits under the state of North Dakota’s medical assistance program.  CHAND has paid out one million dollars on behalf of the individual.
  2. The individual becomes an inmate or a resident of a public institution.
  3. The individual has requested termination of coverage.
  4. The individual has failed to pay the required premium within the 31-day grace period.
  5. The individual has physically resided outside the state for more than 182 days of each calendar year unless the individual has been absent from the state for a verifiable medical reason as determined by the Board.
  6. The individual fails to respond to an inquiry from the Lead Carrier concerning his/her eligibility or place of residence within 30 days.

Note:  If an individual’s coverage is cancelled, they may enroll again only after a minimum of 12 months has lapsed since termination.

Waiting Period

Waiting periods do not apply to individuals that are eligible for CHAND as a HIPAA applicant.
 

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