The Children’s Health Insurance Program, or CHIP, is a state health insurance plan for children. Depending on income and family size, working Utah families who do not have other health insurance may qualify for CHIP.
Children who may qualify for CHIP must meet income guidelines and be:
|Family Size||Maximum Gross Income Per Month||Maximum Gross Income Per Year|
|2 (single parent & one child)||$2,743||$32,930|
*2018 Income Guidelines
The Department of Workforce Services (DWS) is under contract to complete all applications and process eligibility. After 2 -3 business days, you may call DWS at 1-866-435-7414 to complete your interview and/or to find out what verifications are needed to determine your eligibility. You may also go to MyCase for more information and to view the status of your case. It may take 4 – 6 weeks to process your application. If there are parts of the application that are incomplete, the process will take longer.
For a complete listing of services and co-pays, call your health plan, or print the CHIP co-pay summary.
Your health plan will send you a packet with covered expenses, information about pre-authorization, and a list of providers you may use. This packet will arrive with your insurance card. Call your health plan if you don’t get it within 4-6 weeks of enrolling.
CHIP is funded by the state and federal governments. CHIP families also contribute through co-pays and premiums.
CHIP is administered by the Utah Department of Health. CHIP currently contracts with SelectHealth and Molina Healthcare of Utah to provide health care services. Additionally, CHIP contracts with Premier Access to provide dental care services.
The following describes who does not pay co-pays or premiums:
CHIP does not consider pre-existing conditions when determining eligibility for your child. There are no pre-existing condition waiting periods for CHIP.
CHIP has two (2) health plans. You get to pick which one you want. Your HPR will give you a chart to help you pick. Your health plan will:
Here are the health plan phone numbers:
801-858-0400 or toll-free 1-888-483-0760
801-442-5038 or toll-free 1-800-538-5038
Here is the dental plan phone number:
Your dental and health plan should send you a card within 4-6 weeks of enrolling. If you don’t get your card, call the dental and health plan that you chose. If you lose your card, please call your dental or health plan.
If you add a new member to your family, call the DWS Eligibility Services Center to update your case (1-866-435-7414). Once you have updated your case, a new card will be mailed to you for that new family member.
Call your CHIP health plan and they will help you. (In some cases you will need to pay for services and then be reimbursed.)
If you already have kids on CHIP, but you are having or adopting another baby, call DWS (1-866-435-7414) to see if your new child qualifies for CHIP.
Most CHIP families are required to pay a premium every quarter. By paying your premiums, you are helping CHIP cover more children. The premium (up to $75/quarter) is a set amount no matter how many children you have. American Indians do not have to pay premiums or co-pays for services.
The Department of Workforce Service (DWS) Business Office will send an invoice when your premiums are due. You will receive a new invoice every three (3) months, starting with the first month that your child enrolled in CHIP.
DWS has monthly payment options available for you, too. Just call the DWS Business Office and ask.
You may choose any of the following ways to pay your premiums:
Late Fee. It is very important that you pay your premium on time. If you do not pay it by the due date, a $15 late fee will be charged to your account. You will then have to pay the premium and the late fee to keep your child on CHIP. If you do not pay your premium, your case will be closed.
Most people on CHIP are required to pay premiums and co-pays. But, CHIP will not ask you to pay more than 5% of your family’s income (minus your CHIP quarterly premiums) in co-pays and premiums per benefit year. Save your co-pay receipts so you can show how much you paid. If you think you may be getting close to this amount, call us at 1-866-608-9422 or send an email to email@example.com.
The benefit year is 12 months of CHIP coverage, beginning with the month your child became eligible for CHIP. The benefit year starts over in that month, every year. Check with DWS if you do not know which month your child’s CHIP coverage began.
If your income or household size changes, you may qualify for a lower cost CHIP plan. You may also qualify for a different medical assistance program. To find out, you may ask for an early review. If you still qualify for CHIP, the following changes occur:
You are required to call your eligibility worker to:
Your child cannot have other insurance and be on CHIP unless a parent who lives or works in another state has enrolled your child in his/her insurance plan but:
If you get insurance for your child while they are on CHIP or if the non-custodial parent provides insurance for your child, you must tell DWS within ten (10) days.
Unless the other insurance coverage for your child meets one of the exceptions above, your child cannot have CHIP in addition to other insurance coverage. If this happens your will have an overpayment. You will be responsible for paying back the amount of the premium the State has paid to your child’s health plan (SelectHealth or Molina) for each month that your child was ineligible for CHIP.
CHIP enrollees are automatically enrolled in the Utah Clinical Health Information Exchange (cHIE). The cHIE provides a safe place for participating healthcare providers to share and view patient medical information.
Once you enroll your child in CHIP, your child’s participation status is set to PARTICIPATE. This will remain in effect unless you change it, or your child changes it after s/he turns 18 years old. You have the right to change your child’s participation status to not participate in the cHIE at any time. For more information or to opt out of cHIE participation, visit My cHIE or talk to a healthcare provider.