AGENCY: Department of Health and Human Services. Healthcare Administration. Division of Integrated Healthcare. Office of Medicaid Operations.

SERIES: 25216
TITLE: Children's Health Insurance Program (CHIP) premium remittance forms
DATES: 2002-
ARRANGEMENT: Chronologically

DESCRIPTION: This record series consists of remittance forms returned to the agency with payments made by parents or legal guardians of children receiving medical coverage through the Children's Health Insurance Program (CHIP) which is administered under guidelines provided in 42 CFR 7.21 (2002). The program provides medical coverage for children in the state of Utah not otherwise covered by health insurance. This state program receives federal funds through the Tobacco Master Settlement Agreement of 1998, as well as state funds. In order to qualify to participate in the program a child must be under the age of 19, a citizen of the United States or legal resident and fall within program income guidelines. Parents are billed quarterly for the health insurance. Information includes name of parent or guardian, case number, address and amount paid. May also include credit card numbers.

RETENTION

Retain for 7 year(s)

DISPOSITION

Destroy.

RETENTION AND DISPOSITION AUTHORIZATION

Retention and disposition for this series were specifically approved by the State Records Committee.

APPROVED: 01/2004

FORMAT MANAGEMENT

Paper: Retain in Office for 1 year and then transfer to State Records Center. Retain in State Records Center for 6 years and then destroy.

APPRAISAL

Administrative Fiscal

Records in this series have temporary fiscal and administrative value and may be destroyed according to the retention schedule.

PRIMARY DESIGNATION

Private