Who Is Eligible for WVCHIP?
- Reside in West Virginia
- Are under age 19
- Are not eligible for West Virginia Medicaid
- Income & family size fall within qualifying Income Guidelines
- Public Employees' children who meet the WVCHIP Eligiblity Requirements
- Are United States citizens or qualified aliens (Children who are not U.S. citizens must provide verification of their alien status.)
American Indian or Native Alaskan Eligibility
Children who are members of federally recognized American Indian or Native Alaskan tribes are not required to pay co-payments once enrolled in the West Virginia Children’s Health Insurance Program.
If your children are members of a federally recognized American Indian or Native Alaskan tribe, please call the WVCHIP toll-free helpline at 1-877-982-2447 to see if they are eligible for free health insurance coverage.
Click here for a list of federally recognized tribes.
Income Guidelines (Whose Income is Counted?)
WVCHIP income guidelines are based on family size. Family size means the number of individuals you have claimed on your federal tax return. See chart here.
- Expecting A Child
If you are expecting a child and would like the child to be counted as a part of your family size to qualify for WVCHIP, the pregnancy must be confirmed with a doctor's statement. After the child has been born and you want to apply for coverage for the child under WVCHIP, you can call the Department of Health & Human Resources, Customer Service Center (DHHR CSC) at 1-877-716-1212. All claims related to the child will be put on hold by WVCHIP until a social security number has been reported to the DHHR CSC for the child being born. Please remember to apply for the child's social security card right away and report the social security number immediately upon receiving.
|
Family Size
|
WVCHIP Gold
Minimal Co-Pays Only
|
WVCHIP Blue
All Co-Pays Apply
|
WV Premium Plan
All Co-Pays Apply
|
|
Per Month
|
Annual
|
Per Month
|
Annual
|
Per Month
|
Annual
|
|
2
|
$2,289
|
$27,465
|
$3,220
|
$38,635
|
$4,578
|
$54,930
|
|
3
|
$2,879
|
$34,545
|
$4,050
|
$48,594
|
$5,758
|
$69,090
|
|
4
|
$3,469
|
$41,645
|
$4,880
|
$58,553
|
$6,938
|
$83,250
|
|
5
|
$4,059
|
$48,705
|
$5,710
|
$68,512
|
$8,118
|
$97,410
|
|
6
|
$4,649
|
$55,785
|
$6,540
|
$78,471
|
$9,298
|
$111,570
|
|
7
|
$5,239
|
$62,865
|
$7,370
|
$88,431
|
$10,478
|
$125,730
|
* If a family has signed up to have a provider listed as their child's medical home provider, and they go to see that provider, they will be exempt from the $5 copays for their medical appointments. There is a $5 copay for Covered Brand Name Prescriptions.
**Add $3,400 (annually) for each additional member over 8
Click here for information about co-payments.
What types of documents can I use to verify my income?
- Income is confirmed on the federal income tax hub.
How Is Income Counted for WVCHIP?
Income is based on taxable income and number of individuals you have claimed on your federal tax return.
|
Examples On How To Calculate Your Monthly Income
|
| If Your Pay Check Is… |
To Find Your Monthly Amount (Before Taxes) |
Monthly Income Result |
Weekly
52 checks per year |
Multiply by 4.3
$175.35 x 4.3
|
= $754
|
Bi-Weekly
26 checks per year |
Multiply by 2.15
$350.70 x 2.15
|
= $754
|
Semi-Monthly
24 checks per year |
Multiply by 2
$377.00 x 2
|
= $754
|
Bi-Monthly
6 checks per year |
Divide by 2
$500 divided by 2
|
= $250
|
Quarterly
4 checks per year |
Divide by 3
$750 divided by 3
|
= $250
|
Semi-Annual
2 checks per year |
Divide by 6
$1,500 divided by 6
|
= $250
|
Annual
1 check per year |
Divide by 12
$3,000 divided by 12
|
= $250
|
Where can my family get health care if we don’t meet the WVCHIP guidelines?
There are other insurance coverage options available for those that don't qualify for WVCHIP. West Virginia has a program called WV Navigator that can provide more information about coverage through the Marketplace and provide free enrollment assistance in Marketplace health insurance plans. The program can be contacted at (304)356-5834 or online at www.ACANavigator.com.
There are also many facilities in the state of West Virginia that offer discounted or free services to families who do not have health insurance. Click on one of the resources listed below for more information:
West Virginia Primary Care Association
WV Free Clinics and Community Health Centers
Hill-Burton Act