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Children’s Health Insurance Program Notice

COVID-19 ALERT

In response to the current public health emergency, the Pennsylvania Children’s Health Insurance Program (CHIP) is making temporary changes to its program requirements. These changes are designed to ease access to CHIP and to keep families enrolled in CHIP for the duration of the public health emergency. The following changes are in effect until the end of the public health emergency:

  • Families will not be denied or disenrolled from coverage for administrative or financial reasons. An example of an administrative reason is not being able to provide proof of income.
  • Families who cannot provide paperwork to verify information on an application or renewal, can provide self-attestation of information by signing the application or renewal. Self-attestation is done when a family completes and signs an application or renewal, or provides another signed statement that confirms the information provided is true and correct. Electronic or hand-written signatures are acceptable.
  • Families will not pay a copay for services that are for COVID-19 screening, testing or treatment.
  • Families will be given more time to pay premiums, if needed.

The following program requirements are still effective:

  • Families still must provide verification of information presented on an application. At the end of the public health emergency, families will be required to provide verification of information presented (or attested to) on applications or renewals if requested.
  • Families are still responsible for copays for services not related to COVID-19.
  • Families are still responsible to pay premiums if applicable. If a family is unable to pay premiums because of a decrease or loss of income, the family must contact the MCO immediately.
  • A family can request the MCO to perform a “reassessment” because of an income change at any time.

What Do These Changes Mean to You

If you are receiving a request for information, you must still do your best to provide the information to the MCO as requested. You will not be disenrolled from CHIP during the public health emergency for not providing the information, but you will be required to provide it as soon as possible. You must also provide either a signed application, signed renewal or a statement that is signed which attests that the information you are providing is true and correct to the best of your knowledge. Signatures can be electronic or hand-written. You may be asked to provide documentation of information that you self-attested to at the end of the public health emergency.

If you are receiving a request for premium, you still must pay the premium. If you cannot pay the premium on time because your income is decreased or you’ve lost employment, please contact your MCO immediately.

If you did not provide information about your child or children’s date of birth, social security number or tax filing status on an application, you must contact the MCO right away and provide that information. Your application cannot be processed without that information.

If you have any questions about your responsibilities, please contact your MCO at:

Highmark
PO Box Caring
Pittsburgh, Pa. 15230
1-800-543-7105

Last updated: 4/10/2020


What is CHIP?

The Children’s Health Insurance Program (CHIP), brought to you by Highmark, provides comprehensive health insurance coverage to children under 19 years old, regardless of household income. There are no medical questionnaires and no pre-existing condition limits.

 

A History with Highmark

Highmark helped set up the original CHIP program in Pennsylvania, which was signed into law in 1992. The first child was enrolled in May of 1993. Since then, the PA CHIP program has become the model for every other CHIP program across the country. See why Highmark may be a great fit for your health care needs.

 

COVERAGE


What's Covered?

 

CHIP coverage can be used for the following health services:

  • Doctor visits
  • Immunizations
  • Annual checkups
  • Diagnostic testing and lab work
  • Prescription drugs
  • Dental care
  • Vision care
  • Hearing care
  • Emergency care
  • Outpatient surgery
  • Inpatient hospital stays
  • Mental health
  • Substance abuse programs
  • Home health care
  • Rehabilitation therapy

Covered Doctors & Facilities

COSTS


There are three different cost levels of CHIP:

 

  • Free CHIP
  • Low-Cost CHIP
  • Full-Cost CHIP

Free CHIP is truly free. It does not cost you anything. Low-Cost and Full-Cost CHIP require monthly premiums and copays on some services. Use the income guidelines below to see which CHIP plan you’re eligible for. The covered benefits are the same for all three.

 

Income Guidelines

 

Your household income will determine your out-of-pocket costs.

Download Income Guidelines

 

What do I pay?

 

Once you know which CHIP coverage you’re eligible for, you can use the following charts to estimate your out-of-pocket costs.

 

Monthly Premiums

Program One Child Two Children Three or more Children
Free CHIP $0 $0 $0
Low-Cost CHIP 1 $59.73
$119.46 $179.19
Low-Cost CHIP 2 $83.62
$167.24 $250.86
Low-Cost CHIP 3 $95.56
$191.12 $286.68
Full-Cost CHIP $282.70
$565.40 $848.10
View more rates View less rates

*Highmark Blue Cross Blue Shield does not increase the monthly premium amount after 3 kids, regardless of how many are in your household.

*Rates effective July 1, 2020.

 

Copayments for Visits and Prescriptions

 Program PCP Specialist Emergency Brand Name Drug Generic Drug
 Free CHIP No cost No Cost No Cost No Cost No Cost
 Low-Cost CHIP 1, 2, &3 $5* $10 $25 $9 $6
 Full-Cost CHIP $15 $25 $50* $18 $10
View more copays View less copays

*No copay required for preventive health services on the Highmark Preventive Schedule. Preventive Schedules are available to Highmark members on their member portal.
Log in to your Highmark account

*Emergency Room copay is waived if admitted.

 

ELIGIBILITY


CHIP Eligibility Requirements

 

  • The child is a Pennsylvania resident
  • The child is not currently enrolled in health care coverage nor are they eligible for Medical Assistance or Medicare
  • The child is under 19 years old
  • The child is a US citizen, a permanent legal alien or a refugee as determined by the US Immigration and Naturalization Service

Please call 1-800-543-7105 for eligibility questions.

 

ENROLL AND RENEW


Want to sign-up for CHIP?

 

There are 3 ways you can enroll or renew:

 

ONLINE

COMPASS Website

You will need to mail in your income verification documents

BY PHONE

Call 1-800-543-7105 to enroll for assistance with paper renewals

BY MAIL
BY MAIL

To enroll:
Fill out the Application form and mail it, along with the other required documents to:

Highmark CHIP
P.O. Box CARING
Pittsburgh, PA 15230-9779

Solicitud para cobertura de atencion medica

SCHEDULE A LEAD SCREENING FOR YOUR CHILD


Your children could come into contact with lead from lead paint found in many older homes or from drinking the water out of lead pipes. High levels of lead in the blood can learning problems, slowed growth and aggressive behavior. Children under the age of 6 are at the greatest risk. Luckily, a simple blood test from your doctor can determine if your child’s lead levels are too high. CHIP covers all necessary screenings so schedule an appointment with your doctor today.

HEALTH AND WELLNESS RESOURCES


Highmark members have access to a wide variety of resources to help you get healthy, save money and more.

Highmark Preventive & Bright Futures Schedule

Preventive or routine care helps us stay well or finds problems early, when they are easier to treat. The preventive guidelines on this schedule depend on your age, gender, health and family history.

Health & Wellness

Programs, discounts and support you need to live a healthier life.

Health Blog

Health advice, tips, news and more from our team of experts.

Blue 365 Deals

Membership has it’s benefits! Get Discounts on travel, eye glasses, and so much more.

Highmark Healthy YouTube

Watch Videos to help you live your best life.

 

COUNT ON BLUE


When you’re with Highmark, there’s always somebody you can count on anywhere, anytime. Learn more.

Blues on Call

Get 24/7 health support from a Registered Nurse Highmark Health Coach by calling 1-888-BLUE-428.

Telehealth

Video conference consultations with a physician anytime, anywhere - 24/7.

Log In

Log into your Highmark account to check your claims, benefits, provider information, and more.

CHIP Member Handbook

CHIP Member Handbook, Preventive Schedule and Agreement

Medical Policy

The "Highmark Medical Policy" helps you search for details about managed care, procedures, and more. Read and accept the acknowledgment page first to begin.

COMMUNITY PARTNERS


If your organization is interested in partnering with Highmark to help promote the Children’s Health Insurance Program (CHIP), by Highmark providing you with applications and informational brochures to distribute to your clients or at events in your community, please contact:

Diana Kobus, Director, CHIP Program
Diana.Kobus@highmark.com

 

In the service areas of Western, Northeastern, and Central Pennsylvania, uninsured children and teens under age 19 may qualify for coverage through Pennsylvania’s Children’s Health Insurance Program (PA CHIP) if they are not eligible for Medical Assistance (Medicaid).

In the service area of Delaware, uninsured children and teens under age 19 may qualify for coverage through the Delaware Healthy Children’s Program (DHCP) if they are not eligible for Medical Assistance (Medicaid).

In the service area of West Virginia, uninsured children and teens under age 19 may qualify for coverage through West Virginia’s Children’s Health Insurance Program (CHIP) if they are not eligible for Medical Assistance (Medicaid).