Member Resources
Important changes to your children’s CHIP eligibility process
Important changes have been made to the CHIP program due to guidance from the federal government. These changes are intended to ensure CHIP families maintain access to health care.
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).
- Benefits
- Member Handbook
Summary of Benefits Booklet
Exclusions Booklet
Pharmacy Benefits Booklet
Explanation of Benefits Tutorial
Invoice Tutorial
- Eligibility
- 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
Prior Authorization Metrics for Medical Items and Services (Excluding Drugs)
To comply with the CMS Interoperability and Prior Authorization final rule, CHIP is required to annually report aggregated prior authorization metrics on our website. This includes a list of all medical items and services (excluding drugs) that require prior authorization, as well as data on prior authorization requests for those items and services (approvals, denials, etc.) during the previous calendar year. Publicly reporting these metrics promotes transparency and accountability, helps patients understand prior authorization processes, and enables providers to evaluate payer performance. In addition, metrics can be used to compare plans, programs, and payers. If you have questions about the data below, please contact Member Services.
These are the medical items and services for which we require prior authorization (excluding drugs)
Beginning Jan. 1, 2026, the CMS Interoperability and Prior Authorization final rule requires CHIP to send prior authorization decisions within:
- 72 hours for expedited requests (urgent)
- 7 calendar days for standard requests (nonurgent).