What CHIP covers: Health benefits for your child

Details of CHIP benefits for your family

The Children’s Health Insurance Program (CHIP) provides comprehensive health coverage for uninsured children and teens in Pennsylvania. All children receive the same benefits in CHIP, regardless of the plan’s cost.

CHIP benefits are designed to ensure access to healthcare that children need to stay healthy and thrive.

What’s covered under CHIP?

CHIP covers the essential health services that your child needs to grow strong and stay healthy. Here’s a look at what is included with CHIP coverage:

  • Doctor visits and well-child checkups.
  • Specialist care.
  • Pre- and post-natal care.
  • Diagnostic and laboratory tests.
  • Immunizations, including vaccines required by your child’s school.
  • Prescription medications.
  • Dental care.
  • Medically necessary orthodontia.
  • Vision care.
  • Hearing services.
  • Home healthcare.
  • Behavioral health and mental health.
  • Emergency services.
What's covered under chip? Preventive care, dental care, vision care, behavioral health, emergency care, and specialty care

What is not covered by CHIP?

While CHIP provides broad health coverage for children, there are a few services that are not included. It’s important to understand these exclusions to avoid unexpected costs. Here’s a look at some common services that CHIP does not cover:

  • Cosmetic procedures that are not medically necessary.
  • Over-the-counter medications, unless prescribed.
  • Long-term care.
  • Experimental treatments.
  • Orthodontics services that are not medically necessary.

Same benefits at every cost level

CHIP coverage does not vary by income. Children enrolled in CHIP receive the same comprehensive benefits, whether they qualify for free, low-cost, or full-cost CHIP.

For more information, visit our CHIP Costs page.

Benefits that support growing kids

Our CHIP plan offers many benefits and services, including the important areas below. To see a full list, read the CHIP member handbook, also available in Spanish.

  • Preventive care = healthy development with fewer problems
    • Preventive care visits with a child’s primary care physician (PCP) are important for ensuring your child’s health and catching potential physical and mental health issues early.
  • Nutrition and physical health = stronger kids with fewer sick days
    • CHIP covers preventive care, including immunizations and well-child visits. These essentials keep your child on track with growth, nutrition, and developmental milestones.
  • Dental care = confident smiles
    • CHIP benefits include dental cleanings, exams, and treatments to help protect your child’s health and improve their confidence.
  • Vision care = better learning and fewer headaches
    • Your child’s school progress could be affected by undiagnosed vision problems. CHIP includes vision care for eye exams and glasses, if they need them.
  • Mental health support = healthier social skills
    • Stress, anxiety, and behavior issues can be difficult for your child. Your CHIP coverage includes mental and behavioral health services, supporting your child’s emotional well-being.
  • Emergency care = peace of mind
    • Accidents happen! Your CHIP coverage includes emergency care for your child, so you don’t need to worry about the unexpected. Learn what problems need emergency room care and which can be treated by your child’s PCP or at an urgent care center.
  • Specialist care = valuable answers from trusted providers
    • If your pediatrician recommends a specialist, CHIP ensures access to expert care. From allergies to developmental delays and more, specialists are important for your child’s health. Keep in mind that some procedures must be approved before you head to the doctor.

Care management for CHIP members

One of the ways to get the most out of your child’s CHIP benefits is through care management. Our experienced registered nurses and licensed social workers provide personalized support, education, and coordination of services for a variety of conditions. Care managers can help with:

  • Managing chronic conditions such as asthma and diabetes.
  • Supporting moms and babies with special needs.
  • Finding resources for behavioral health issues.

To learn more, call us at 888.545.4512 or complete the member self-referral for care management form.

Frequently asked questions about CHIP benefits

Does CHIP cover everything my child might need?

CHIP covers most essential health needs, but there are some exclusions. Always check with your provider or insurance company if you’re not sure.

How are CHIP health benefits different from other insurance plans?

CHIP health coverage offers many of the same benefits as private insurance, but often at a lower cost to families (or no cost at all). CHIP is designed as an affordable option for kids under 19 who don’t qualify for medical assistance.

Does CHIP cover autism services for children?

Yes. CHIP covers a range of services for children with autism, including behavioral health treatments, occupational therapy, speech therapy, and more.

Can I apply for CHIP benefits any time of the year?

Yes! You can apply for benefits any time of the year. You don’t need to wait for open enrollment.

How long can my child receive CHIP benefits?

Your child will be enrolled and can receive CHIP benefits for 12 months. You will have to complete a CHIP renewal to continue benefits before your child’s 12 months of eligibility ends.

Where can I find a full list of CHIP benefits?

You can review a summary of CHIP coverage in this printable PDF, also available in Spanish, or contact us at 800.KIDS.101 to request a paper copy.