Children’s Health Insurance Program in Pennsylvania

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The Children’s Health Insurance Program (CHIP) provides health coverage for families who do not qualify for Medical Assistance (MA) and who are not able to meet the expense of private insurance. CHIP is funded by states and the federal government, but it is administered by states. Below is information on how to apply for CHIP in Pennsylvania.

Eligibility

Your child may qualify for CHIP in Pennsylvania if he or she is:

  • Under 19 years old
  • A U.S. citizen, U.S. National, or Qualified Alien
  • A Pennsylvania resident (living in Pennsylvania)
  • Uninsured and ineligible for Medical Assistance

Cost

  • Your income does not matter in terms of your eligibility, but it does matter in terms of what you will pay for CHIP coverage. The cost of coverage varies and changes annually depending on the number of members in your household and your household annual gross income. The cost of coverage will vary between free, low cost, and full cost.
    • For example, as of April 2013, if a household of four members makes between $23,050 and $46,100, the cost of coverage is free; if income is between $46,101 and $69,150, the family may pay a low cost for coverage; if household income is $69,151 or more, the family will pay the full cost of coverage. (Note that families of four who make less than $23,050 may qualify for Medical Assistance, as of April 2013).
  • The cost of CHIP coverage means the amount a family pays for the monthly premium and for co-pays for services.
  • In order to qualify for the low cost and full cost CHIP programs, your child has to have been uninsured for 6 months. A 6 month period of no insurance coverage was written into law to prevent families from dropping out of their private insurance coverage to enroll in a public program and to prevent employers from doing the same to their employees. CHIP is primarily for families who have no other option for health insurance coverage.
    • There are exceptions to the 6 month wait rule; the 6 month wait may be waived if a child is under 2 years old, if the child is uninsured because the parent became unemployed, or if the family is moving from Medicaid to CHIP.
  • Families must renew annually to maintain or keep CHIP coverage. While it is not automatic, it should be an easy process. CHIP or your insurance company will send you a renewal form 90 days prior to when your child’s coverage ends. Your insurance company can also walk you through the process.

Benefits

CHIP is a comprehensive insurance coverage package; you cannot elect to have certain benefits and not others. For example, you cannot have dental benefits only. The list of benefits for CHIP includes: Immunizations, Routine Check-ups & Well Visits, Prescription Drugs, Dental, Vision, Hearing Services, Emergency Care, Mental Health Benefits, Hospitalization, Durable Medical Equipment, Substance Abuse Treatment, Partial Hospitalization for Mental Health Services, Rehabilitation Therapies, Home Health Care, and Maternity Care.

How to Apply

There are several ways you can apply:

  • Online with COMPASS: COMPASS is PA’s online application system, so you can apply for other services using just one application. The system walks you through the questions, and the application is submitted immediately and directly.
  • CHIP Insurance Companies: You can apply through insurance companies that provide CHIP coverage in your county.
  • Mail: You can download and print an application, and send it by mail to a participating CHIP insurance company.

After receiving all necessary documents (remember to send in proof of income such as pay stubs!), you should be notified within 4-6 weeks whether your child/children are eligible for CHIP.

Children with Disabilities

When you complete the application for CHIP, the application will also be considered for Medical Assistance. For children with disabilities who will require more supportive services, your application may be reviewed for Medical Assistance, regardless of your household income.

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Last Updated: August 14, 2020

The Center for Autism Research and The Children's Hospital of Philadelphia do not endorse or recommend any specific person or organization or form of treatment. The information included within the CAR Autism Roadmap™ and CAR Resource Directory™ should not be considered medical advice and should serve only as a guide to resources publicly and privately available. Choosing a treatment, course of action, and/or a resource is a personal decision, which should take into account each individual's and family's particular circumstances.


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