CHIP Frequently Asked Questions

Applying

How do I complete the application?

Include the following individuals, whether you are applying for them or not:

  • Yourself
  • Your spouse or unmarried partner
  • Anyone under 21 who lives with you
  • Anyone you include on your tax return, even if they don’t live with you

Be sure to answer all questions and include income documentation. An incomplete submission will delay processing.

See our list of acceptable documentation.

If additional information is needed, it will be noted on the application.

How soon will I be notified after you receive my child’s application or renewal?

Allow three to four weeks for your application or renewal to be processed and notification to be sent.

Must children be uninsured for six months before applying?

If a child has no insurance, they may apply for CHIP immediately. If a child’s health insurance is ending, you may apply for CHIP before the end date by submitting a Certificate of Credible Coverage with the application as proof of the termination date.

When can I apply for CHIP for my unborn baby?

You must wait to apply until the child is born. A social security number is not needed to initially apply but must be added to your application once available.

If I am not a US Citizen, but my child is, may I apply for CHIP for my child?

Yes, the citizenship status of the parent does not affect CHIP eligibility. A child must be a citizen of the United States, a U.S. National or a lawfully-residing resident as determined by the United States Citizenship and Immigration service.

Eligibility

Is there CHIP coverage for adults?

CHIP is only for uninsured children up to age 19. Adults can apply for health insurance with Capital BlueCross or the health insurance marketplace.

If I enroll in a health insurance plan through my employer, do I have to remove my child from CHIP?

Children can stay on CHIP as long as they meet the eligibility requirements and are not enrolled in Medical Assistance. CHIP coverage must be renewed each year.

What are the income requirements and costs for CHIP?

See our income eligibility guidelines and program costs.

Can I get portions of this coverage that are not covered under my own health insurance?

No. CHIP coverage cannot be used with any other health insurance plan.

I live in another state. Can I get coverage for my children with CHIP through Capital BlueCross?

No. Our CHIP plans are only available to residents living in the Capital BlueCross service area.

Is grandparents’ income used to determine CHIP income eligibility?

Grandparents’ income must be included when reporting household income, but it is not used to determine eligibility unless the grandparent adopted their grandchildren.

May a child have other insurance coverage and remain on CHIP?

No other medical coverage is allowed. A child may have a stand-alone dental and/or vision plan. If this is the case, CHIP dental and/or vision coverage will be considered secondary insurance coverage.

Does CHIP offer Guest Membership for CHIP members?

Yes.  Guest membership is only available for detached families and students. The guest membership only applies if the child will be out of the area for 3-6 months.

Are children’s Social Security benefits used to determine income for CHIP applications or renewals?

Social security benefits of children are not counted when determining eligibility for CHIP unless the child has other income requiring them to file a tax return.

What documentation is needed when a parent has started a business but has not yet filed their income taxes?

A profit/loss statement must be submitted for the period that the business has been active.

May a social security card be used to document citizenship?

No.

Does CHIP coverage continue beyond the age of 19?

No, CHIP coverage ends at the end of the month of the child’s 19th birthday.

Can I appeal if CHIP says I’m ineligible?

If you do not agree with the eligibility decision, you may submit a written request for an impartial review within 30 days from the date on your decision letter. Please promptly submit:

  • a written, dated request stating why you disagree with our decision
  • a copy of the entire letter you received about our decision
  • any additional documentation to support your case
  • a phone number where you can be reached during the day

Mail to:

Capital BlueCross
PO BOX 777014
2500 Elmerton Avenue
Harrisburg PA 17110-9956

Or fax to:
717.651.8592

We may contact you for more information. If we cannot resolve your issue, we will forward your written request and any additional information to the Pennsylvania Insurance Department. You may receive more detailed information from the Pennsylvania Insurance Department, including the time and date that a phone interview will be held, if needed.

Using Your Coverage

When searching for a provider, what plan should I choose?

To find a provider, choose HMO (Capital BlueCross & Health Insurance Marketplace).

When searching for a dentist, what plan should I choose?

To find a dentist, choose BlueCross Dental PPO.

How do I change my child’s Primary Care Physician (PCP)?

To change your child’s PCP, call Customer Service at 800.KIDS.101.

May a CHIP member register on capbluecross.com to get contract information?

CHIP members cannot currently access contract details through the website, but can register to view secure emails.

May a child’s head of household make an initial payment using the automated IVR system?

No, initial payments must always be made with a check or money order to activate the contract.

What is the PH95 Loophole Program?

PH95 is a program through the Department of Public Welfare allowing Medical Assistance coverage for children under 18 with a severe disability, Autism Spectrum Disorder or a behavioral disorder regardless of the parents’ income.

If a child qualifies for Medical Assistance under the PH95 loophole must they move to the Medical Assistance program and terminate their CHIP coverage?

Yes, if the child qualifies under the PH95 program the parent must move to Medical Assistance.