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An Overview of CHIP Plans: Enrollment, Benefits & Relevant updates

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Children’s Health Insurance Plan (CHIP) offers medical insurance coverage for those under the age of 19 whose parents earn adequate money to qualify for Medicaid, which is not sufficient to pay for private cover plans. Concisely, it’s a low-cost health coverage plan for children belonging to lower middle-class families. CHIP also covers low-income pregnant women in some states. Created in 1997, as a part of the Balanced Budget Act, CHIP was started to build on Medicaid coverage for children with low income. States can use federal CHIP funds to expand their Medicaid program or create a standalone program, or a combination of both. CHIP’s primary aim is to expand the scope of government-funded health care coverage to include more low-income children. 

Providing health insurance to millions of uninsured children in the US, the Children’s Health Insurance Plan (CHIP) is one of the most used programs during Covid-19. This plan is covered by each state, and works in sync with its state Medicaid program. 

Understanding Children’s Health Insurance Plan (CHIP)

Numerous CHIP-covered medical services are free but others require a co-payment. Some states also allow a monthly premium that cannot surpass 5% of the household’s annual income. Typically, the CHIP covers annual inspections, immunizations, doctor visits, hospital care, dental and vision care, prescriptions, laboratory services, X-rays, and emergency services. Some states extend coverage even to parents and pregnant ladies.

There is no specific time of the year to apply for CHIP and find out if your child is eligible for it or not! So, the parents who qualify for Medicaid may sometimes enroll their child in CHIP so they don’t have to buy the coverage.

Eligibility for CHIP

Currently, you can apply for CHIP during any time of the year and find out whether you qualify for it or not. If you apply to the state agency for Medicaid coverage, you can also find out if the kids are eligible for CHIP. When they qualify, you do not need to buy an insurance plan to protect them.

Regardless of the family size and income, if your child or teen meets the following conditions, he or she may be eligible:

  • Beneath the age of 19
  • A Citizen of the USA
  • National or legally present person of the USA
  • Children who are living in Pennsylvania legally are eligible for CHIP irrespective of their parents’ immigration status
  • Uninsured and not eligible for Health/Medical Assistance

Note: For grandparents – The CHIP coverage for your grandchildren is not based on your income, unless you have legally adopted the children. 

Following children are ineligible for CHIP:

  • Public institution inmates 
  • Patients in a mental diseases institution
  • Eligible for health coverage under a State health benefits plan because of a family member’s employment with a public agency

CHIP for Low-Income Pregnant Women

Under the CHIP state plan, states can give CHIP benefits to uninsured low-income pregnant women. States can cover delivery, parental, and postpartum care. However, to cover pregnant women under CHIP, states need to abide by certain conditions, such as:

  • States need to cover pregnant women under Medicaid up to at least 185% of the Federal Poverty Level (FPL)
  • States also need to cover children below 19 years of age under CHIP or Medicaid up to 200% of the FPL

The newborn babies are automatically eligible for CHIP or Medicaid without any application or determination of eligibility. 

How to apply for CHIP?

If your child fulfills the above-mentioned conditions, s/he is eligible for CHIP. You are advised to keep the following information handy while applying for CHIP:

  1. Income: All sources of income including employment, pension, social security, etc. and most recent tax return information
  2. Social Security Numbers (SSN) and birthdates of all members of the family or applicants
  3. Information related to private health insurance (if you have or had any in the last 90 days)
  4. Daycare expenditures (if any)
  5. Work transport expenditures (if any)

Now, let’s understand the process by which you can confirm the eligibility or can apply for CHIP. You can apply for CHIP online, by email, or by phone. 

  • You can call at CHIP helpline number available online.
  • You can also apply online by filling the online application form. You need to submit the completed application form immediately and directly.
  • You can also download a paper application form either in English or Spanish and submit the signed application. You will be informed within four to six weeks whether your child is eligible for CHIP. If you have submitted an incomplete application form, it will delay the process. Once you are notified about the eligibility of your child, the insurance benefits will start from the first day of the next month. 

Note: If you have applied for CHIP through a health insurance company, you can track the status of your application simply by contacting your company. 

Benefits of CHIP

Under CHIP, your children get full coverage of high-quality benefits, including: 

  • Vaccinations 
  • Routine health check-ups 
  • Prescription Medicines 
  • Odontology 
  • Vision and eyesight 
  • Maternity care
  • Psychiatric advantages 
  • Hospitalization for up to 90 days/year 
  • Safe medical devices 
  • Personal Emergency Treatment
  • Palliative and hospice services
  • Orthodontics Medically Required
  • Autism and associated spectrum disorder
  • The diagnosis of drug abuse 
  • Part mental health hospitalization 
  • Rethinking treatments 
  • Personal Emergency Treatment

Relevant Updates on CHIP

The CHIP funding has been extended for an additional 10 years. The combination of this extension and the earlier approved funding will ensure CHIP and critical program components for the coming decade. The extension will provide much needed health security to millions of children in families with low income. The step has been applauded by children’s hospitals across the States. CHIP is providing health cover to millions of children who are not eligible for Medicaid. 

The Children’s Health Insurance Program (CHIP) model notice has been revised again by the Department of Labor (DOL). The revised notice states that employers are expected to give annually to workers living in any state specified in the notice where a health program is operated or maintained by the employer.