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  Frequently Asked Questions (FAQ’s)
  What is CHIP?
Who is eligible for CHIP?
When can I apply?
How do I apply for CHIP?
I turned in my application, what do I do now?
Why does Utah need CHIP?
How is CHIP paid for?
What does CHIP cover?
Who operates the CHIP program?
What are the co-payments for CHIP?
What if my child has a pre-existing condition?
How do I choose a health plan?
When will I get my medical card?
What should I do if my children need health care before we get the medical card?
Will I get a new card if I add a family member to CHIP?
How do I know what is covered by CHIP?
What are premiums?
What is the maximum I need to pay?
What are the dates of the benefit year?
What if my income changes?
Am I required to report changes in my eligibility?
What if my child is covered by other insurance after my child is approved for CHIP?
What happens if my child has been covered by other insurance for awhile, and I did not report it or I did not know about it?
Where is my local office?
Who does not pay co-pays or premiums?
Will my child’s medical information be added to the cHIE?

   
   
 

1. What is CHIP?
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.
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2. Who is eligible for CHIP?
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

*2013 Income Guidelines

Family Size
Maximum Gross
Income Per Month

Maximum Gross
Income Per Year

2
$2,585
$31,020
3
$3,255
$39,060
4
$3,925
$47,100
5
$4,595
$55,140
6
$5,265
$63,180
7
$5,935
$71,220

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3. When can I apply?
Apply anytime. CHIP is now accepting applications year-round.
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4. How do I apply for CHIP?
Apply for CHIP online or print and mail an application.
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5. I turned in my application, what do I do now?
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.
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6. Why does Utah need CHIP?
Children without health insurance often don't get regular health care. They may wait until an emergency occurs when they are sicker and treatment costs more. CHIP is a good call for kids.
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7. How is CHIP paid for?
CHIP is funded by the state and federal governments. CHIP receives four federal dollars for each state dollar. All state funding is from the Tobacco Master Settlement Agreement. CHIP families also contribute through co-pays and premiums.
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8. What does CHIP cover?
• Well-child exams
• Immunizations
• Doctor visits
• Hospital and emergency care
• Prescriptions
• 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.
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9. Who operates CHIP?
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 and DentaQuest to provide dental care services.
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10. What are the co-payments for CHIP?
Click here to view/print the CHIP co-pay schedule.
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11. What if my child has a pre-existing condition?
CHIP does not consider pre-existing conditions when determining eligibility for your child. There are no pre-existing condition waiting periods for CHIP.
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12. How do I choose a health plan?
CHIP has 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:

• Molina
801-858-0400 or toll-free 1-888-483-0760

• SelectHealth
801-442-5038 or toll-free 1-800-538-5038

Dental
• Premier Access
Toll-free 1-877-854-4242

DentaQuest
Toll-free 1-800-483-0031
(DentaQuest is only available to those living in Salt Lake, Utah, Davis and Weber counties)
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13. When will I get my medical card?
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.
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14. What should I do if my children need health care before we get the medical card?
Call your CHIP health plan and they will help you. (In some cases you will need to pay for services and then be reimbursed).
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15. Will I get a new card if I add a family member to CHIP?
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.

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16. How do I know what is covered by CHIP?
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.
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17. What are premiums?
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.
  • Phone.
    • DWS Business Office 1-866-435-7414 (select option 5)
      (Monday - Friday, 8 a.m. - 5 p.m.)
  • Mail.
    • Department of Workforce Services
      Business Office
      PO Box 143250
      Salt Lake City, UT 84114-3250

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.
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18. What is the maximum I need to pay?
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 (801) 538-6728. .
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19. What are the dates of the benefit year?
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.
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20. What if my income changes?
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
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21. Am I required to report changes in my eligibility?
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.
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22. What if my child is covered by other insurance after my child is approved for CHIP?
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 or her insurance plan coverage but the plan does not provide coverage or 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.
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23. What happens if my child has been covered by other insurance for awhile, and I did not report it or I did not know about it?
Unless the other insurance coverage for your child meets one of the exceptions in question #22, 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.
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24. Where is my local office?
Your local Department of Workforce Services Employment Center. To find the office nearest you click here.

You may also contact your eligibility office by calling toll-free 1-866-435-7414.
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25. Who does not pay co-pays or premiums?

  1. 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)
  2. CHIP families that do not have income in the benefit year do not have to pay co-pays or deductibles for CHIP covered services.
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26. Will my child’s medical information be added to the cHIE?
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 consent status is set to PARTICIPATE. This will remain in effect until your child turns 18 years old. You have the right to change your child’s consent 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.
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