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Member Resources

Important changes to your children’s CHIP eligibility process

Starting April 17, 2023, the Pennsylvania Department of Human Services (DHS) began determining eligibility for CHIP applications and renewals. DHS now handles all communications related to eligibility and application/renewal processing.

Read DHS’s notice and FAQ about these changes.

Documents you may need

On this page you can find electronic copies of many UPMC for Kids resources, including documents, forms, and more. If you would like printed copies instead, please call a Health Care Concierge at 1-800-650-8762 (TTY: 711).

Member Handbook
Summary of Benefits Booklet
Exclusions Booklet
Pharmacy Benefits Booklet
Explanation of Benefits Tutorial
Invoice Tutorial
Application Form
Renewal Form
Income Guidelines Chart
Reimbursement forms
Prescription Drug Claim Form
Out-of-Network Care Claim Form
Flu Shot Reimbursement Form
Member rights and privacy
Personal Representative Designation Form
Member Authorization to Use or Disclose Protected Health Information
Privacy Statement
UPMC for Kids Notice of Privacy Practices
Pennsylvania Department of Human Services’ Notice of Privacy Practices
UPMC for Kids Member Rights and Responsibilities
Caring for Kids newsletter archive
Issue 1, 2023
Issue 1, 2022
Issue 2, 2021
Apple Store Google Play