Children who may qualify for CHIP must meet income guidelines and be:
- Under age 19
- Not currently covered by health insurance
- US citizens or legal residents
|Family Size||Maximum Gross Income Per Month||Maximum Gross Income Per Year|
|2 (single parent & one child)||$3,278||$39,444|
*2023 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.
- Well-child exams
- Doctor visits
- Hospital and emergency care
- Hearing and eye exams
- Mental health services
- Dental care
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 and Human Services. CHIP currently contracts with SelectHealth and Molina Healthcare of Utah to provide healthcare services. Additionally, CHIP contracts with Premier Access to provide dental care services.
The following describes who does not pay co-pays or premiums:
- American Indian and Alaska Native children do not pay co-pays or quarterly premiums. A CHIP enrollee must provide tribal membership verification. The tribe must be recognized by the federal government. Acceptable verification of American Indian and Alaska Native status include:
- Tribal Identification/Enrollment Card or Number
- Certificate of Degree of Indian or Alaska Native Blood (CDIB) signed by the Bureau of Indian Affairs (BIA)
- Indian Health Services (IHS) Face Sheet (IHS Face Sheet is a medical record certified by IHS as being from their original records)
- CHIP families that do not have income in the benefit year do not have to pay co-pays or deductibles for CHIP covered services.
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:
- Process your medical claims
- Send you medical cards
- Send you a booklet of health care providers for you to choose from
- Pre-authorize procedures when needed
Here are the health plan phone numbers:
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.
During the public health emergency, CHIP members were not required to pay their regular quarterly premiums. Starting in May 2023, CHIP will start charging premiums again. For more information, please read this letter opens in a new tab.
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:
- Online opens in a new tab
- DWS Business Office 1-866-435-7414 (select option 5) (Monday – Friday, 8 a.m. – 5 p.m.)
- Department of Workforce Services
PO Box 143250
Salt Lake City, UT 84114-3250
- Department of Workforce Services
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.
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:
- A new 12-month benefit year begins
- You will have a new 5% maximum amount for co-pays and deductibles
- The 5% maximum amount starts over
- Co-pays, deductibles or premiums paid in the previous benefit year do not count toward the new benefit year’s maximum out-of-pocket amount
You are required to call your eligibility worker to:
- Report changes in your household, like family size, income changes, etc.
- Let them know if you move to a new address or out of state.
- Let them know, within 10 days, if you enroll in other health insurance.
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:
- The plan does not provide coverage,
- The plan provides only limited coverage in Utah, or
- The insurance is not a comprehensive plan.
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.
Your local office is a Department of Workforce Services Employment Center. You may contact your eligibility office by calling toll-free 1-866-435-7414.
As of July 1, 2021, CHIP covers ABA services and ASD related physical, occupational, and speech therapy for all members who are eligible for CHIP plans B and C. Families can contact their CHIP health plan for a list of network providers who can provide ABA services.