Once your child is enrolled in CHIP their coverage must be renewed each year. Capital BlueCross is required to determine that enrolled children continue to be eligible for coverage. This process is called renewal.
Ninety (90) days before your child's enrollment is about to expire, Capital BlueCross will send you a renewal letter and form. The renewal form must be completed and returned to verify that your child continues to be eligible for CHIP. If you need a renewal form you may request one by calling our customer service department at 1.800.KIDS.101. Or you may download a renewal form by using one of the links below.
It is very important that we receive the renewal form before the deadline indicated in your letter or your child's coverage will expire. Allow plenty of time for mailing. We are required to cancel your child's coverage on their anniversary date if we do not receive a properly completed renewal form and income verification by the deadline date indicated in the letter.
Do not forget to include income documentation. Acceptable forms of income documentation are:
At least one of your most current pay stubs. If you do not receive pay stubs, your employer can provide a letter that indicates your gross income and how often you are paid. This letter should be on company letterhead. W-2s or other tax forms are not acceptable (except if you are self-employed - see below).
Visit the State's website and print BOTH your current claim summary and benefit payment history. If you do not have access to a computer, please provide the most current award letter. We do not accept 1099 tax forms.
The most recent Federal income tax return including all schedules and forms associated with that tax return. If this is a new business or a substantial change in income from the previous year, we can accept a year to date profit and loss ledger which must include the gross income, line item expenses and the net profit. We do not accept 1099 tax forms.
A copy of the most current Federal income tax return, a copy of the most current 1099 tax form or a statement from your financial institution.
A copy of the benefit award letter. If you do not have a copy of the award letter, you may request a copy.
A copy of the most current award letter or most current pay stub.
Provide at least one of the most current check stubs, a bank statement, or the disbursement statement.
Must have current documentation as proof of 'other' income.
Income documentation must be from within the last 60 days, except in an instance where it is appropriate to send a tax form.
Income documentation must show the amount of income you received before taxes and other deductions.
If there are any special circumstances regarding your income, please explain in detail on a separate sheet of paper.
If you are mailing, separately from the application, any income or other documentation needed, please be sure to include your name or your child's name on the documentation.
Please send copies of the income documentation. Originals will not be returned.
You may send your completed application and/or income documentation to:
PO Box 777014
2500 Elmerton Avenue
Harrisburg, PA 17110-9956
Or fax to: 717-651-8592