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individuals & families Frequently Asked Questions

UPMC is excited to offer UPMC for Kids, a state-sponsored children's health insurance program.


Who needs coverage?

  • There are over 195,000 children receiving CHIP coverage in Pennsylvania.
  • Approximately 50,000 eligible children remain uninsured.

What is the UPMC for Kids service area?

Service area includes 35 counties primarily in Western Pennsylvania: Adams, Allegheny, Armstrong, Beaver, Bedford, Berks, Blair, Butler, Cambria, Cameron, Clarion, Clearfield, Crawford, Dauphin, Elk, Erie, Fayette, Forest, Greene, Huntingdon, Indiana, Jefferson, Lancaster, Lawrence, Lehigh, McKean, Mercer, Northampton, Potter, Somerset, Venango, Warren, Washington, Westmoreland, and York.


Who is eligible?

Based on a family's size and income, a child may be eligible if he or she is:

  • Under the age of 19
  • A U.S. citizen, U.S. National, or Qualified Alien
  • A resident of Pennsylvania
  • Not eligible for Medical Assistance
  • Uninsured. Families with annual income above free CHIP limits must show that the child has been uninsured for six months. This does not apply if the child:
    • Is younger than age 2; or
    • Lost health benefits because a parent lost his or her job; or
    • Is moving from another public insurance program; or
    • Is eligible for free CHIP (most families qualify for free CHIP).

Children are eligible for free (no cost) CHIP health insurance if the annual family income is no greater than 200% of the Federal Poverty Level (FPL). Children are eligible for low-cost (small monthly payment) CHIP health insurance if the annual income is over 200% and less than 300% of the FPL. Children are eligible for full-cost (larger monthly payment) CHIP health insurance if the annual income is over 300% of the FPL.

For example, a family of four earning $44,101 to $66,150 could be eligible for low-cost CHIP. A family of four earning more than $66,150 could be eligible for full-cost CHIP.


What about copayments?

Please note that copayments have been added for some services for children enrolled in the low-cost CHIP and full-cost CHIP programs. There are no copayments for free (no-cost) CHIP.


How long do children stay covered?

If children continue to meet CHIP's eligibility requirements, they can be covered up to age 19. Eligibility is reviewed on an annual basis.


How can a family apply?

A parent or legal guardian may obtain a CHIP application from multiple sources, such as a County Assistance Office, a hospital, or a community agency.

UPMC for Kids applications are available to all interested families. Here's how:

  1. Call UPMC for Kids at 1-800-978-8762.
  2. Call the Pennsylvania Insurance Department's CHIP Helpline at 1-800-986-KIDS
  3. Apply online via COMPASS (Commonwealth of Pennsylvania Access to Social Services) (www.COMPASS.state.pa.us).

What is covered under UPMC for Kids?

Doctor visits, including routine checkups and immunizations; diagnostic tests; prescriptions and some over-the-counter medications; dental care, orthodontia (braces, not for cosmetic reasons, only when medically necessary); vision and hearing services; emergency care; maternity care; mental health and substance abuse services; hospital care up to 90 days per year; durable medical equipment up to $5,000 per year; physical, occupational, and speech therapy; home health care; tobacco cessation*; nutritional counseling*; and medical nutritional therapy.*

*Enhanced benefits that are offered by UPMC for Kids and are not part of the standard CHIP benefit package