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Peehip premium assistance form 2026

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The document outlines the application process for the Federal Poverty Level (FPL) Premium Assistance and the Children's Health Insurance Program (CHIP) under the Public Education Employees' Health Insurance Plan (PEEHIP). It includes required subscriber information, eligibility criteria based on family income relative to the Federal Poverty Level, and instructions for submitting tax documentation. The document also details premium discounts available based on income levels and emphasizes the need for annual reapplication during Open Enrollment.

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Click ‘Get Form’ to open the peehip premium assistance form in the editor.
Begin by entering your personal information in the 'PEEHIP Subscriber Information' section. Ensure that your name matches exactly as it appears on your Social Security card, and provide your Social Security Number.
Fill in your mailing address, including city, state, and ZIP code. Don’t forget to include your home and work phone numbers for contact purposes.
Indicate your marital status by selecting from the options provided. If you are applying for CHIP, answer whether any child is covered under Medicaid and list household members accordingly.
Complete the requested effective date field and indicate if you wish to enroll children under the PEEHIP Hospital/Medical Plan if they do not qualify for CHIP.
Attach a signed copy of your prior year’s Federal Income Tax Return along with supporting documents as instructed before submitting the form.

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What is premium assistance discount Peehip?

PEEHIP can provide some assistance to its members by giving a discount on Hospital Medical premiums based on (1) family size and (2) total combined household income. Active and retired members may apply.

How do I find my Peehip PID?

Your PID can be found at the top right of paper correspondence from PEEHIP. If you do not know your PID, please click \u201cNeed a PID? (Request PID Letter)\u201d for steps to have your PID mailed to you at your current mailing address on file with the RSA.

What is Peehip supplemental medical plan?

The PEEHIP Supplemental Medical Plan is designed to only supplement your primary insurance plan by covering the copay, deductible and/or coinsurance of your primary insurance plan or the preferred/participating allowance, whichever i s less.

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