Eligibility and Benefits

For most families, CHIP is free. A household with income above a certain level can receive CHIP at low-cost or full-cost.


Boy with a frog

Key Requirements

To qualify for enrollment in CHIP, you child must meet these eligibility requirements:

  • A child must be under the age of 19
  • A child must be a resident of Pennsylvania
  • A child must be a U.S. citizen, a lawfully admitted alien with permanent status or a refugee as determined by U.S. Immigration and Naturalization Services
  • A child must be uninsured and not eligible for or enrolled in Medical Assistance

CHIP Income Limits and Eligibility Requirements for a Family of Four1

  • Free coverage, if you earn up to $53,560
  • Low cost coverage, if you earn up to $80,855
  • Full cost coverage, if you earn more than $80,855

Benefits

CHIP health insurance covers all of the services you would expect under a quality plan including:

  • Preventive coverage such as doctor's office visits, well-child care and immunizations
  • Specialist care
  • Pre and post natal care
  • Emergency medical and accident care
  • Diagnostic and laboratory tests
  • Mental health services
  • Prescription drugs
  • Preventive, routine and emergency dental, vision and hearing care
  • Inpatient and partial hospitalization
  • Home health care
  • Substance abuse
  • Home medical equipment (DME)

CHIP Eligibility Guidelines

Are you eligible for free or low-cost health care coverage?

  1. Locate the number of people in your household.
  2. Find the box that matches your household's annual gross income and age of your children.
  3. Look down the column to see your monthly cost per child and the copayments per child, per visit.

Example: A four-person household with an annual income of $69,840 will pay a monthly premium of $70 per child, plus any copayments for services.

Household Size Income Level 
Ages 1-5		 Income Level 
Ages 6-18
1 $ 19,610 — $ 25,980 $ 16,612 — $ 25,980
2 $ 26,549 — $ 35,173 $ 22,491 — $ 35,173
3 $ 33,489 — $ 44,367 $ 28,369 — $ 44,367
4 $ 40,428 — $ 53,560 $ 34,248 — $ 53,560
5 $ 47,367 — $ 62,754 $ 40,127 — $ 62,754
6 $ 54,307 — $ 71,948 $ 46,005 — $ 71,948
7 $ 61,246 — $ 81,141 $ 51,884 — $ 81,141
8 $ 68,186 — $ 90,335 $ 57,762 — $ 90,335

Cost
Monthly Premium Per Child $ 0.00 $ 0.00

Copayments Per Child Per Visit
Doctor Visit $ 0.00 $ 0.00
Brand Name Prescription $ 0.00 $ 0.00
Generic Prescription $ 0.00 $ 0.00
Specialist Visits $ 0.00 $ 0.00
ER Visits2 $ 0.00 $ 0.00

Income

Household Size

Income Level

Ages 0-1

Income Level

Ages 1-18

Income Level

Ages 0-18

Income Level

Ages 0-18

1

 $ 26,854 — $ 32,724 $ 25, 980 — $ 32,724 $ 32,724 — $ 35,972 $ 35, 972 — $ 39,219
2 $ 36,357 — $ 44,305 $ 35,173 — $ 44,305 $ 44,305 — $ 48,701 $ 48,701 — $ 53,098
3 $ 45,860 — $ 55, 885 $ 44,367 — $ 55,885 $ 55,885 — $ 61,431 $ 61,431 — $ 66,977
4 $ 55,363 — $ 67,465 $ 53,560 — $ 67,465 $ 67,465 — $ 74,160 $ 74,160 — $ 80,855
5 $ 64,866 — $ 79,046 $ 62,754 — $ 79,046 $ 79,046 — $ 86,890 $ 86,890 — $ 94,734
6 $ 74,369 — $ 90,626 $ 71,948 — $ 90,626 $ 90,626 — $ 99,620 $ 99,620 — $ 108,613
7 $ 83,872 — $ 102,207 $ 81,141 — $ 102,207 $ 102,207 — $ 112,349 $ 112,349 — $ 122,492
8 $ 93,375 — $ 113,787 $ 90,335 — $ 113,787 $ 113,787 — $ 125,079 $ 125, 079 — $ 136,371

Cost
Monthly Premium Per Child $ 55.00 $ 55.00 $ 70.00 $ 80.00

Copayments Per Child Per Visit
Doctor Visit $ 5.00 $ 5.00 $ 5.00 $ 5.00
Brand Name Prescription $ 9.00 $ 9.00 $ 9.00 $ 9.00
Generic Prescription $ 6.00 $ 6.00 $ 6.00 $ 6.00
Specialist Visits $ 10.00 $ 10.00 $ 10.00 $ 10.00
ER Visits2 $ 25.00 $ 25.00 $ 25.00 $ 25.00

Income

Household Size

Income Level

Ages 1-18
1 $ 39,219 — No Limit
2 $ 53,098 — No Limit
3 $ 66,977 — No Limit
4 $ 80,855 — No Limit
5 $ 94,734 — No Limit
6 $ 108,613 — No Limit
7 $ 122,492 — No Limit
8 $ 136,371 — No Limit

Cost
Monthly Premium Per Child $ 284.82

Copayments Per Child Per Visit
Doctor Visit $ 15.00
Brand Name Prescription $ 18.00
Generic Prescription $ 10.00
Specialist Visits $ 25.00
ER Visits2 $ 50.00

If your income is below any amount listed, your child could be eligible for Medical Assistance. For more details, please call 800.543.7101.

1 Dependent on your income, your child may be enrolled in Medical Assistance. Commonwealth of PA guidelines require weekly wages to be calculated at 48 payments and biweekly wages to be calculated at 24 payments. 

2 Emergency room visit copayment applies if the child is not admitted for a hospital stay.

CHIP coverage is issued by Keystone Health Plan® Central through a contract with the Commonwealth of Pennsylvania. BlueCross Dental℠ and BlueCross Vision℠ are issued by Capital Advantage Assurance Company®. Capital Advantage Assurance Company and Keystone Health Plan Central are subsidiaries of Capital BlueCross. All are independent licensees of the BlueCross BlueShield Association. Communications are issued by Capital BlueCross in its capacity as administrator of programs and provider relations.