Beginner’s Guide to the CHIP Insurance Program

The Children’s Health Insurance Program (CHIP) makes it possible for children in qualifying households to receive access to medical care. Throughout the nation, health insurance is expensive. This is especially true for families that have multiple children. While employers usually provide health insurance options for full-time workers, not every parent has the option to obtain affordable medical insurance for their children. 

To help make health care more accessible for children in lower-earning families, CHIP was created. This program is different from Medicaid, and has more lenient income requirements. Each state administers its own CHIP program, so enrollment may be slightly different from one part of the country to the other. However, all benefits are designed to ensure children have access to the preventative and emergency care they may need. 

Learn About CHIP Program Benefits 

There are many different benefits that children enrolled in the CHIP program can receive. Since individual states manage this insurance program, the states can determine to some degree what benefits they offer enrollees. However, there are certain types of coverage that all CHIP insurance programs throughout the nation must provide to beneficiaries. This includes: 

  • Wellness visits. States are required to provide babies and children with access to general wellness visits. This is to ensure that children are developing at healthy rates. 
  • Dental coverage. CHIP programs throughout the nation need to provide enrollees with basic access to dental coverage. Usually, these packages include benefits that can be used for preventative and restorative care. 
  • Vaccines. There are certain routine vaccines that children are required to receive before they can enroll in school or participate in other programs with their peers. With CHIP, children can receive the shots they need. 
  • Behavioral and mental health services. In certain instances, enrollees can use their CHIP benefits to access mental and behavioral health services. However, families should contact their local agents to determine which services are available to them through this program. 

Depending on your state, additional programs may be available to your children. If you have specific questions as to what coverage your dependents can receive, contact a CHIP representative near you. It is important that you understand what benefits are available for your child before you seek medical services. Otherwise, you will be responsible for paying whatever your insurance does not cover.

What are the requirements for CHIP?

There are certain eligibility requirements that states have in place to determine which children can receive CHIP insurance benefits. However, enrollment criteria varies from one state to another. 

For example, one state may require enrollees to serve a waiting period before they can begin collecting benefits. Other states may not. Therefore, it is important that you understand your state’s CHIP program to determine if your child will qualify for benefits. 

Like with Medicaid, there is an income requirement you need to meet in order to receive CHIP program insurance. Most states require your household to have an income that is 200 percent or more of the federal poverty level (FPL). On the other hand, other states require your income to be 250 or 300 percent of the FPL or more. 

There is also an age requirement your children need to meet in order to qualify. Only uninsured children who are younger than 19 years of age can collect benefits. Keep this in mind before you attempt to enroll your children in benefits. 

How to Apply for CHIP Insurance 

There are two methods you can use to apply for the CHIP insurance program. The first method is by phone. Alternatively, you can apply for coverage online. To complete this task, you must submit your application through the Health Insurance Marketplace. 

If you take advantage of this online option, your state agency will reach out to you if you qualify for benefits. Furthermore, remember that you can apply for benefits at any time. The earlier you submit your application, the sooner you can be considered for benefits. 

When you are ready to apply for CHIP coverage, there are specific documents you need to provide with your application. These items prove that your children qualify for benefits. Usually, you need to submit: 

  • Social Security Numbers (SSNs) for you and your children. 
  • Your children’s birthdates. 
  • Proof of any health insurance you currently have. 
  • Proof of income, such as tax documents, pay stubs and government funds you receive. 
  • Information about any health insurance policies that are available to you through your employer, if applicable. 
  • Documents that verify your immigration status, if applicable.  

Information You Need to Provide in the CHIP Program Application

When you apply for CHIP coverage, you will need to answer specific questions about your household. The questions included in this program application are intended to help your state agency determine if you qualify for benefits. 

Since the coverage is for your children, some of the questions will be about you and your child’s other parent while others are about your children. You will need to provide information about the following topics: 

  • Your immigration status 
  • Your current employment situation 
  • How the children in your household are related to you
  • Information about your child’s other parent 

What can I do if I am denied CHIP insurance?

If you are denied CHIP insurance, this does not mean you have no other ways you can seek coverage. If you believe the denial is inaccurate, you can appeal this determination. Different states will likely have their own appeals processes you need to follow. However, you can usually obtain a form online, which you can use to appeal your denial. In many states, you have 90 days to file your appeal. 

When you submit your form, be sure to provide any additional documentation you have that supports your claim. Representatives will review your new information and issue a redetermination, if necessary. This is considered an informal determination. 

However, if you do not agree with the informal assessment you receive, you can request to have a formal hearing for your appeal. Many of these hearings take place by phone, which is usually more convenient for you and anyone else involved in your hearing process. 

After the hearing takes place, the government will issue its new determination for your case. If you disagree with this decision, there may be additional steps to appeal that you can take.