Frequently Asked Questions
About CHIP and Health Partners Plans

CHIP stands for the Children's Health Insurance Program - Pennsylvania's program to provide health coverage to all children and teens who are uninsured and not eligible for Medical Assistance.

There are a lot of reasons kids might not have health insurance; maybe their parents lost a job, don't have health insurance at work or it simply just costs too much. Whatever the reason, CHIP may be able to help.

CHIP is administered by private health insurance companies that are licensed and regulated by the Pennsylvania Insurance Department and have contracts with the Commonwealth to offer CHIP coverage.

Your child or teen may be eligible for CHIP if they are: 

  • Younger than 19 years old 
  • A U.S. citizen, a U.S. national, or a lawfully residing noncitizen 
  • A resident of Pennsylvania 
  • Uninsured 
  • Not eligible for Medicaid 

Check your child's eligibility for Pennsylvania CHIP here.

You can easily apply for CHIP online through Pennsylvania's application portal, COMPASS.

If your child qualifies for CHIP in Pennsylvania, enrolling in Health Partners Plans CHIP is easy! Visit our How to Enroll page to get started.

No. In Pennsylvania, CHIP coverage is available to all uninsured children and teenagers under 19 years of age who are not eligible for Medical Assistance. No family makes too much for CHIP coverage.

For many families, it’s free. Families with incomes above the free CHIP limits will pay low monthly premiums and copays for some services.

Yes. If you are the legal guardian exercising care and control of a child who is uninsured and in need of health benefits, you can apply for CHIP. This can include parents, stepparents, grandparents or foster parents who are legal guardians.

No family earns too much for a child to enroll in CHIP. There is no upper income limit. Your monthly premium will depend on your child’s age, family size, and family income. View the CHIP income guidelines chart to see where your family falls.

Once enrolled, children are guaranteed 12 months of CHIP coverage unless they no longer meet the basic eligibility requirements. Families must renew their coverage every year in order to continue coverage. CHIP insurance companies send renewal notices 90 days before benefits expire, and families must fill out and send the renewal information back to their CHIP insurance company in order for benefits to continue.

No. There is no waiting list to enroll in CHIP.

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Costs / Premiums

Health Partners Plans CHIP accepts monthly premium payments such as checks, money orders, credit card or debit card payments. Your child’s premium is billed and due before the coverage month. 

Premiums are regular monthly payments you must make to keep your health care plan active. You must pay your monthly premium even if you don’t need medical services during a specific month. Learn more about monthly premiums for Health Partners Plans CHIP members here.

 

Copays are flat fees you pay for covered services like visiting the doctor or filling a prescription.

Monthly premium rates vary depending on if your child receives free, low-cost or full-cost CHIP coverage. Visit our premiums page to learn more.

Enrollment

All paper and online applications include language stating that you must mail or fax proof of current income. However, you are NOT required to send proof of income with an application. We will try to verify all income through electronic databases. If we cannot verify income electronically, we will ask for paper income documentation. In that case, you are responsible for providing the necessary information.

Call the CHIP helpline at 1-800-986-KIDS (5437) and select prompt 2, then select prompt 1 for application assistance. A CHIP representative will assist you with applying or answer any questions you may have.

If you have questions about Health Partners Plans CHIP or the benefits we offer, our friendly Member Relations team is here to help. Call us at 1-888-888-1211 (TTY 1-877-454-8477).

Member Resources

You can find a list of your child’s benefits on our CHIP plan page or in your member handbook. If you have any questions, our Member Relations team is here to help. Call us at 1-888-888-1211 (TTY 1-877-454-8477).

Some services may require a copayment. Copay amounts depend on if your child is part of the free, low-cost or full-cost CHIP premium categories. View more information on copays here.

Your member handbook will have the latest information on covered and non-covered services. The member handbook and other important resources can be found here.  

If you have any questions, the member portal is a great place to start. Here, you can order a new ID card, change your child’s doctor, access personalized benefits information and more. Click here to login.

If you would like to request a Member Handbook or other KidzPartners information in a language other than English, at no cost, please call KidzPartners’ Member Relations department at 1-888-888-1211 (TTY 1-877-454-8477).

If you need an interpreter for any language, including sign language, or if you require TTY services for your healthcare needs, Member Relations can help you. Just call 1-888-888-1211 (TTY 1-877-454-8477).

If you need an interpreter and you call Member Relations, we have an online interpreter service that can help you. This service provides over 140 languages and is available 24 hours a day, seven days a week. There is no cost to you for these services.

You will not have to make another telephone call to get this service. Member Relations will do this for you and will stay on the telephone with you. If you call the TTY line, you will be connected to a text telephone right away.

Member Newsletter

Printed copies of the newsletter are mailed to each household. If you need an additional copy or would like to confirm your mailing address, please call Member Relations at 1-888-888-1211 (TTY 1-877-454-8477). You can also download a copy on our Newsletter page. 

We share our newsletter two times a year including spring/summer and fall/winter editions.

Fitness Offerings

Depending on each participating fitness center’s policies, you may be able to register your child for a membership over the phone. Call the participating fitness center or visit their website to learn more about their enrollment policies. 

If you need help using the fitness center locator above, call Member Relations at 1-888-888-1211 (TTY 1-877-454-8477).

Once you choose a participating fitness center for your child, you may not choose a different center for one year.

You are responsible for paying for any classes, activities or events that are not included in the fitness center’s membership fee.

Obtaining Care

You can search for a provider by their name or specialty. You can also search for providers in your area by entering your zip code. Click here to learn more.

We update the provider directory frequently. It includes information provided by doctors, hospitals or pharmacies. Click here to browse the online provider directory.

If you have any questions about in-network providers, please call Member Relations at 1-800-553-0784 (TTY 1-877-454-847).

Your child’s doctor can help refer you to a specialist for your child’s care. Referrals are not needed for routine dental, vision or OB/GYN care. Please see the Health Partners Plans CHIP Member Handbook for more information about specialists and referrals.

Outpatient laboratory services are provided through our preferred laboratory partner, Quest Diagnostics. We also contract certain hospitals for lab services. You can find participating locations via our online directory.

To request a printed copy of the provider directory, call Member Relations anytime at 1-888-888-1211 (1-877-454-8477).

The Health Partners Plans CHIP formulary contains two kinds of drugs: brand name and generic. This could affect which medications your child gets. When you search for a brand name drug on the formulary, you will see a generic equivalent (if available). View our formulary for more information.

Health Partners Plans CHIP works with local doctors and pharmacists to select the drugs in the formulary. We choose drugs that are safe, effective and high quality. New drugs and treatments are reviewed regularly. We make changes to the formulary as needed.

Your child’s doctor must ask us to approve your child’s medication. This is known as prior authorization. When we receive a complete request for prior authorization, we will contact you by phone to tell you if we approved the service or item requested.

Health Partners Plans CHIP typically limits medications to a 30-day supply. However, we offer an option for chronic medications to be dispensed for a 90-day supply. This list is subject to change without notice.

A 90-day supply is also available through our mail order pharmacy, CVS/Caremark. Getting your child’s prescriptions by mail is convenient. You will never miss a refill. Your child must have a valid prescription to use this service. Please note, not all covered drugs are available for mail order. To view the complete list of 90 days’ supply medications, click here. To learn more, call 1-800-756-7186 or visit Caremark.com/mailservice.

To view a drug recall list, click here. If you are impacted by a drug recall, you will receive a drug recall from Health Partners Plans CHIP.

To pay the lowest out-of-pocket costs for your child’s prescriptions, you should fill them at an in-network pharmacy. We work with in-network pharmacies to provide lower prices on medications.

You can find a list of our covered prescription drugs here.

In addition to in-network pharmacies, you can find in-network doctors, hospitals, labs and specialty services in our online directory.

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