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Learn About CHIP in Pennsylvania

In Pennsylvania CHIP is a program that was designed to ensure that low-income families with children younger than 19 years of age have access to quality health care even if they have a low income. When children meet the program’s eligibility guidelines and are enrolled for coverage by their parents or guardians, they have comprehensive health insurance coverage that can be used with participating medical providers. This federally funded program is referred to formally as the Children’s Health Insurance Program and is offered in some form in every state. It is ideal for low-income families because there are low monthly premiums or not premiums at all. Additionally, enrollees usually only owe small copayments for extensive medical, dental and vision treatments.

CHIP insurance in PA is administered by the Department of Human Services (DHS), and the department is responsible for reviewing applications and providing benefits to eligible residents. Potential applicants who think they or their children may be eligible for the program should review the benefits and the eligibility guidelines before completing the CHIP application process. Parents and guardians should keep in mind that there are strict age and income restrictions for the program. To find out more about this health insurance program, review the following sections.

What is CHIP in Pennsylvania?

Parents or guardians of minors looking into health insurance options may wonder “What is CHIP in PA and can my child enroll?” The program provides comprehensive health insurance coverage for medical services, vision care and dental treatments. Children enrolled in this program can seek necessary treatments, whether they are preventive health screening or emergency visits, from participating medical providers for low copayments.

Since both CHIP and Medicaid are government-funded health insurance programs, children who qualify for Medicaid are not eligible for the children’s health plan in addition to this coverage. Parents and guardians cannot choose which health insurance program their children enroll in. If a child is eligible for Medicaid, also referred to as medical assistance in PA, he or she must utilize this coverage instead of CHIP. However, if all eligibility guidelines for medical assistance are not met, it is possible for the child to be eligible for children’s health insurance through the DHS.

Learn more about CHIP in PA by downloading our comprehensive program guide.

Who does Pennsylvania CHIP cover?

The Pennsylvania CHIP application process requires an applicant to provide extensive information on his or her income, household situation, residency status and child who needs insurance. The department does not want to utilize important federal funding on residents who do not truly need this low-cost coverage. Therefore, it sets strict guidelines on these factors to ensure beneficiaries who receive coverage will benefit from it. To meet this PA CHIP eligibility criteria, a program applicant must be:

  • 19 years of age or younger.
  • A U.S. citizen, legal alien or legal permanent resident.
  • A resident of the state of Pennsylvania.
  • Living in a low-income household, according to program guidelines.
  • Not covered by any other insurance, including medical assistance.

A child may still be eligible for CHIP benefits if his or her parents or guardians are not legal U.S. citizens, as long as the child has verifiable legal residency. The low-income guidelines involve having a household income within a certain percentage of the Federal Poverty Level (FPL). Grandparents who are applying for coverage for grandchildren may be exempt from these low-income guidelines.

To find out more about the CHIP, review our comprehensive guide.

How to Apply for CHIP in Pennsylvania

If you are ready to apply for health insurance for kids in PA, you have a few different ways you can choose to complete the application process. You can apply for the program:

  • Online.
  • By mail.
  • By phone.

To apply for CHIP online, you can visit the Department of Human Service’s website and use its online application system, designed specifically for government benefit applications. To apply by mail, you must complete the application, which can be found online and printed or requested from a local agency, and mail it in to a local CHIP insurance company for review.

Before you attempt to apply for CHIP coverage in Pennsylvania by phone, online or by mail, it is important to gather all requested information and documentation. This will make the application process much faster and easier, and it will ensure that you provide thorough and accurate information. You can check the status of your application at any time by contacting the insurance company you sent it to or signing into your online account.

What is included with Pennsylvania CHIP coverage?

Once you have discovered how to apply for CHIP in Pennsylvania, you may want to review the benefits that may be provided if you or your child is approved for the program. The program provides health insurance coverage for medical services and vision care. In addition, CHIP dental coverage is also provided through the program. After being enrolled, keep in mind that you should review the covered services, since only necessary and preventive treatment is covered under the plan. You must also only seek treatment from medical providers who are included on a pre-approved list.

Some of the most common services that CHIP covers include:

  • Prescription drugs.
  • Immunizations.
  • Emergency care.
  • Substance abuse treatment.
  • Mental health benefits.

Upon acceptance into the program, you will receive information on all covered services. You can also contact your CHIP insurance company and speak with a representative before seeking treatment to confirm the service is covered.

How much is CHIP health insurance in Pennsylvania?

The PA children’s health insurance program does not charge any monthly premiums to its beneficiaries who meet specific low-income guidelines. This is what makes it a helpful solution for low-income residents who do not qualify for medical assistance in the state. However, enrollees with slightly higher incomes who still meet eligibility criteria may be responsible for meeting certain CHIP costs, such as low monthly premium payments and copayments for treatments. It is also important for all enrollees to only seek treatment from medical providers who accept this type of insurance.

To find out more about CHIP copayments, download our informative guide.

How long do CHIP benefits last in Pennsylvania?

Once your Pennsylvania CHIP application is approved and you or your child is actively enrolled in the program, coverage will last for one year. However, you can re-apply for another term of coverage if all eligibility criteria are still met. If your child is too old, the household earns too much income or health coverage is being provided elsewhere, you cannot reapply for more coverage. The insurance company sends notification before the CHIP insurance expires, informing you of your potential eligibility status for another term.