CHIP provides health care coverage for Pennsylvania children ineligible for Medicaid.
Pennsylvania provides healthcare coverage for children through its Children's Health Insurance Program, also known as CHIP. The program extends benefits to children who do not have health insurance and who are not enrolled in, or are ineligible for, Medical Assistance, the state's Medicaid program. CHIP does not exclude children with preexisting conditions and does not have a waiting list for enrollment. The program bases eligibility and premium amounts on household size and income, and offers free coverage to qualified low-income children.
History
House Bill 20, also known as the Children's Health Insurance Act, established CHIP, which the governor of Pennsylvnia signed into law in December 1992. Designed to provide healthcare coverage for children from families who do not qualify for Medical Assistance benefits, CHIP became the model for the federal State Children's Health Insurance Program (SCHIP), according to CHIP. Gov. Edward G. Rendell introduced a new initiative in 2007, known as Cover All Kids. The measure expanded CHIP eligibility to all Pennsylvania's uninsured children under 19 years of age who do not qualify for medical assistance.
Eligibility
CHIP bases eligibility on household income and size. Families who earn too much to qualify for free CHIP coverage can still enroll and pay monthly premiums and copayments for certain services. Eligibility also requires participants to be Pennsylvania residents, U.S. citizens or aliens with legal-residency status. Children eligible for Medical Assistance and those with other health insurance coverage cannot qualify for CHIP.
Benefits
CHIP provides comprehensive medical care coverage. Benefits can help pay for immunizations, home health care, prescription medications, substance abuse services, dental care, hospitalization, mental health services and maternity care.
Premiums
CHIP bases costs on family size and income and has an escalating premium and copayment structure for higher income earners. For example, an infant from a family of four with an annual household income of $41,000 can receive free coverage, as of December 2010. Households with four family members and a $60,000 annual income pay an average monthly insurance premium of $60 for each child in the program, along with copayments for certain services.
Copayments
Participants who receive free CHIP coverage do not have to make copayments for any services. Enrollees who pay monthly coverage premiums must also make copayments for certain services. Copayments range from $6 to $50 for services such as doctor visits, pharmacy services, specialist care and emergency medical treatments.
Providers
CHIP makes coverage available through private health insurance companies. Coverage can vary depending on an enrollee's county of residence. Applicants can choose the company they prefer on the basis of the providers in their area. Companies offering CHIP coverage include Aetna, Unison Kids, AmeriChoice, Highmark Blue Cross Blue Shield, Capital BlueCross,and Geisinger Health Plan.
Applying for Coverage
Pennsylvania residents can apply for CHIP coverage online using Compass, the state's online application system. Candidates can also apply by calling 1-800-986-5437 or by downloading an application on the CHIP website to fill out and mail in. Candidates who choose to apply by mail must send their completed application to the insurance company selected as their CHIP provider.
