EEs & CAAs
- Contact Information
- Reference Manual
This program is administered
by the Managed Risk Medical Insurance Board (MRMIB).
AIM Program Changes
Pregnant Women Enrolled in AIM Prior to July 1, 2004
All other AIM eligibility criteria and program rules still apply to pregnant women (regardless of enrollment date) and to babies born to mothers enrolled before July 1, 2004.
Pregnant Women Enrolled in AIM on or after July 1, 2004
The AIM Program will change for women who are enrolled in the AIM Program on or after July 1, 2004. Enrolled means the date an applicant is determined eligible for the AIM Program. Pregnant women enrolled in the AIM Program on or after July 1, 2004, will have a total cost of just 1.5% of the adjusted annual household income. This is a reduction from the 2% cost prior to July 1st, 2004. This cost now only covers the pregnant woman’s 60 day post-partum coverage.
Babies Born to Mothers Enrolled in AIM on or after July 1, 2004
Babies born to mothers enrolled in the AIM Program on or after July 1, 2004 are eligible for enrollment in the Healthy Families Program. Once the baby is registered with Healthy Families (all the required birth information, dental plan selection and premium payment is submitted to HFP) the infant is enrolled in the HFP and their date of birth becomes their effective date of coverage.
HFP Subscriber babies will be billed premiums under Category B rates. Current HFP premium payment rules now apply to newly enrolled infants.
By default, the baby is enrolled in the same health plan in HFP that their mother has through AIM with the following exceptions:
- The baby has siblings enrolled in HFP. In this case, the first two months of coverage, from the baby’s birth date, will be provided by the mother’s AIM plan and the baby will be then transferred to the same plan as siblings, with exception for special needs babies.
A special needs baby with HFP siblings may continue with the AIM health plan, but approval is contingent upon the following:
- Upon notification by the administrative vendor of the baby’s enrollment into the HFP plan, the applicant submits an appeal which describes the infant’s special needs.
- The administrative vendor offers to transfer the HFP enrolled siblings into the AIM plan.
- If the applicant refuses to transfer the HFP enrolled siblings into the AIM plan, the case must be forwarded to MRMIB for approval to maintain a case with children enrolled in separate health plans.
- The applicant requests in writing (within 3 months of birth) a different health or dental plan; follow current HFP transfer rules.
Notification to AIM Subscribers
The AIM application informs the AIM subscriber about her baby’s automatic eligibility for the HFP. She will be advised about her reporting responsibilities when her baby is born and that her baby will be enrolled in the HFP counterpart of her AIM plan. One month before the baby’s due date, the administrative vendor will send the AIM subscriber a packet of material containing the following:
A letter which contains:
- A reminder of her baby’s eligibility for HFP and her responsibility to notify the HFP when her baby in born.
- A form to be completed after the birth of her baby, providing information on the baby’s name, date of birth, gender and birth weight. She will also be asked to designate the HFP primary care provider (PCP) for her baby and make a dental plan selection.
- A request for her to remit one month’s HFP premium, to be applied toward the first full month of her baby’s HFP coverage.
- A copy of the HFP handbook, which will provide important information about the HFP, including how to choose a PCP and available dental plan.
- A postage-paid self-addressed envelope for returning the completed form and premium payment to the HFP after the baby’s birth.
Registration and Enrollment of Babies in the HFP
A baby is enrolled when HFP is notified of the birth information and receives all premiums that are due. Enrollment can occur at any time through the end of the eleventh month following the birth, and will be retroactive back to the date of birth, if all past month’s premiums are paid.
If the enrollment of the baby does not occur by the specified timeframe, the baby is no longer eligible for enrollment, through the AIM related process, and must re-apply for HFP.
HFP Anniversary Date
AIM babies enrolled in HFP are considered to be "added" if a case already exists. All rules and regulations relative to "Adding a Person" would apply (e.g. anniversary date of existing HFP subscribers would change to the effective date of coverage for the newly added AIM infant).
Although there will be changes due to the AIM new vendor, many of the current AIM resources will remain the same. These include:
- The AIM Toll-free line will continue to be 1-800-433-2611.
- The AIM toll-free TTY line will continue to be 1-800-735-2929.
There will be changes with the new AIM administrative vendor. These include:
- The AIM toll-free fax line is now 1-888-889-9238.
- The address to mail AIM applications is now P.O. Box 15559, Sacramento, CA 95852-0559.
- The address to mail AIM payments is now P.O. Box 15207, Sacramento, CA 95851-0207.
- The new AIM application is now available in Chinese, as well as English and Spanish.
- Starting June 14, 2004, AIM Staff will mail out the new AIM application.
- The new AIM Website is available at http://www.aim.ca.gov/.
- The new AIM application is available online at http://www.aim.ca.gov/english/applying_download.html.