Insurance Information

Insurance Information

Purpose: The Insurance Information section of an EI Client Case contains the following fields:

1. Insurance Type – Multi-select

   1. Private Insurance

   2. CHP+

   3. TriCare

   4. None

2. Exemption on File - Check box – Check this box if the EIB intends to access funding other than the child’s insurance and has confirmed that a completed Insurance Exemption form (required) is on file in the child’s record. If there is not an exemption on file for services do not check this box.

   Note: No date needs to be entered into the EI DATA SYSTEM to document when the form was completed, but the completed form must be on file in the child’s record.

3. Reason for Exemption- Drop-down Pick List

   1. System

   2. Provider

   3. Family

4. EI Trust Eligible - Check Box – Select if Private Insurance is selected and the plan is covered (or presumed to be covered) under the Early Intervention Services Trust. If a child is no longer eligible for the Trust, this box will be unchecked by EIST. Please reference the EIST Process User Guide for more detailed instructions surrounding EI Trust Eligibility

5. Health Insurance Authorization Form Date - Calendar

6. Medicaid Enrolled – Pick list - If a user selects Yes and the Medicaid ID is not entered on the Client Contact, users will be prompted to go back and enter the ID on the Contact.