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Pennsylvania Children’s Health Insurance Program

What You Need To Know

Health coverage is provided to a vast number of people in Pennsylvania through the Children’s Health Insurance Program. It has been set up to cater to those families who fall in the middle ground. They are unable to qualify for Medicaid due to high income but cannot afford private insurance. The CHIP has certain changes according to its region of operation. In some states, it is known to provide for parents and pregnant women as well.

The CHIP coverage is decided through collaboration with the Medicaid program of the state. It runs in collaboration of leading health insurance companies. This allows offering a variety of choices with its own physician networks, specialists and care facilities. In some cases, the children can even stick to their current doctors, which help in easy availability of physician services. The Pennsylvania Children’s Health Insurance Program provides the following benefits to its members:

  • Emergency services
  • Laboratory and X-ray services
  • Inpatient and outpatient hospital care
  • Prescriptions
  • Routine check ups
  • Immunizations
  • Doctor visits
  • Dental and vision care

Along with these, there are many other benefits involved in this comprehensive health insurance as well. They can range from mental health care to substance abuse treatment. It is a flexible program that incorporates the health of children from the ages of 0 to 19.

The administration of this program has been carried out by the Centers for Medicare & Medicaid Services (CMS). It has been set up for kids without health insurance. The reason behind this can range from different factors such as parent’s loss of a job or no insurance at work. CHIP benefits help to reduce costs. Through proper implementation of the program, 90% of the CHIP families are able to get the satisfactory benefits. This helps in ensuring good health for the children. CHIP also ensures that all checkups and vaccinations are carried out on time to avoid any issues that may surface.

For qualified families, CHIP coverage is free. But in some cases, certain families have incomes above the free CHIP limits. These families, therefore, have to pay a small amount in order to avail the benefits.


Are You Eligible?

CHIP provides for families that have uninsured children below 19 years old. These families have incomes high enough that it makes them ineligible for Medicaid. To be eligible for this program, the child must be:

  • US national
  • Citizen
  • Legal alien
  • Permanent resident
  • Resident of Pennsylvania
  • Unable to have income that allows private coverage
  • Not eligible for Medicaid

The annual household income is also considered in this regard. The amount considered is before any tax deductions. It needs to be less than or equal to the following figures:

Size Of Household Maximum Annual Income Level ($)
1 37,470
2 50,730
3 63,990
4 77,250
5 90,510
6 103,770
7 117,030
8 130,290

Households that have more than eight residents must add $13260 extra per person. To keep up-to-date with the most recent guidelines, the managing agency must be approached. Therefore, one should stay in touch with the agency in their area to not miss out on any information.

In cases of pre-existing conditions, the eligibility is not affected. These conditions are covered by CHIP or through Medical Assistance. The latter depends on the seriousness of the medical condition.

Once the child is successfully enrolled, he or she is guaranteed with 12 months of health coverage. This is applicable in cases where the children meet the eligibility criteria discussed above. CHIP coverage is renewed on a yearly basis. To make sure the renewal process goes smoothly, the insurance companies involved sent renewal notices. These are received by the families before the 90-day expiry of their benefits. These forms must be completed on time if the families wish to continue their CHIP benefits.


How To Apply

The Pennsylvania CHIP program can be applied for through an online portal. You can find the appropriate application through their Pennsylvania COMPASS. In case any additional information is required concerning the application, you can find it on the website. It has also been made easier for applicants as the application can be downloaded directly from the site.

For Further Information

To approach the appropriate authority in cases of queries, the Pennsylvania CHIP page can be visited. The website has all the necessary information required by parents who might be interested in it. It even has a Frequently Asked Questions section which can be referred to tackle any confusion. The service center can also be easily found through the use of the County Coverage Map. For more detailed information, you can also consider the Medicaid & CHIP policies page. It outlines the information according to the state selected.


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