Wyoming Administrative Code
Agency 048 - Health, Department of
Sub-Agency 0064 - Kid Care CHIP
Chapter 5 - Rules and Regulations for Kid Care CHIP ("Children's Health Insurance Program")
Section 5-11 - Participating Insurance Company
Current through September 21, 2024
(a) No insurance company may provide benefit and claims administration services for Kid Care CHIP, unless it is licensed by the Wyoming Insurance Commissioner as outlined in W.S. 35-25-101 and offers coverage which meets or exceeds benefits outlined in 42 CFR Subchapter D, Part 457, Subpart D, W.S. 35-25-104, and pursuant to Minimal Essential Health Benefits as outlined in Section 2001 of the Affordable Care Act. The participating insurance company must have entered into an agreed upon contract with the Department.
(b) The Department shall provide the participating insurance company with the identity of the eligible enrollees and shall make payments on behalf of those enrollees directly to the participating insurance company as per the agreed upon timeframe and process.
(c) The participating insurance company, upon completion of agreed reconciliation process with the Department, shall submit invoices to the Department, in the manner specified by the Department, to request payment for premiums.
(d) When an insured seeks services, the provider must verify the individual's eligibility with the participating insurance company using the procedures established by the company. If a provider fails to verify eligibility, the Department shall not be responsible for paying such services.
