Enrollees in CHIP are required to pay co-payments, up to a maximum co-payment limit for a family within a specified period of time. The maximum co-payment limit for a family is calculated as a percentage of the family's gross countable income less the total amount payable in CHIP premiums by the family within a defined period of time. The time period to which the co-payment limit applies is based on the certification dates of the product delivery. In general this will be 12 months. When the co-payment limit is reached, no further payments are required by the household for services received.

The co-payment record is created at the time of product delivery creation.

This is a business processing entity which is associated with the Children's Health Insurance Program product delivery. An organization's administrator must administer certain entities when creating and maintaining Children's Health Insurance Program product deliveries.

Example

Susan Smith is a child in a household who is currently receiving Children's Health Insurance. Susan Smith is ill and attends her local doctor. Susan Smith's doctor prescribes her drugs. The doctor issues a bill for the service s/he supplied and the cost of the drugs for Susan Smith. Susan Smith's family have made payments previously for medical services and have reached the household's maximum co-payment limit for this period. Susan Smith is not required to make a co-payment for the medical services provided to her. Susan Smith's health plan must pay the full cost of the medical services provided to her. A case worker will have created Co-payment Receipts for the previous payments the household has made but no record is created for Susan Smith as she is not required to make a co-payment.

A co-payment record exists for the product delivery which specifies the maximum co-payment limit for the assistance unit.