Insurance Exceptions

Children with other insurance, including Medicaid, do not qualify for WVCHIP, unless they meet one of the following exceptions:
  • Your family’s annual health insurance premium cost (only premiums paid for medical, dental and vision are counted) is 5.0 % or more of the family’s gross income; or
  • The total cost of family coverage, including premiums, coinsurance and deductibles, exceed 9.5% of gross household income; or
  • The child must meet all other eligibility criteria including income to enroll in WVCHIP.
  • Your child is covered under the insurance of a non-custodial parent; and the insurance services can only be accessible in another state, or in a geographical area in WV that is considered to be non-accessible.

Note: You will need to submit copies of documents from your employer or insurance company to show changes in coverage or health care premium costs.

If these exceptions are met, the child's other coverage must be closed before the child is enrolled in WVCHIP.


Q. My family's health insurance premium costs over 9.5 % of my gross income. I don’t want to drop their coverage unless I’m sure they can get WVCHIP. What should I do?

A. You should make an appointment with your local WVDHHR office, or apply online at www.wvpath.wv.gov​. You will need to bring proof of your family’s income and the cost of the premium (usually on your paystub). Ask the worker to determine if your kids qualify for WVCHIP. You should not drop coverage unless the child’s eligibility for WVCHIP has been determined. You will receive a denial notice and it will state you are being denied due to the fact you have health insurance. At this time, contact the WVCHIP office, Eligibility Department.  WVCHIP will verify through the DHHR that you qualify under the Income Guidelines, and pay over 9.5 % in insurance premiums.  The application will then be held up to 45 days, pending proof of termination of other insurance coverage from applicant.  WVCHIP will advise you to drop your private insurance, and to fax in a statement that says it has been cancelled.    When the original coverage ends, WVCHIP coverage will begin the 1st day of the following month.

Q. I am a divorced parent. My children receive medical coverage from their other parent. The insurance is not readily accepted in West Virginia. What should I do?

A. If your ex-spouse resides in another State or is a resident of West Virginia and your child is covered under your ex-spouse’s insurance, you may apply to WVCHIP if the accessibility falls within the following guidelines.

Insurance is considered non-accessible when the following travel times are exceeded:
  • Routine medical appointment – 60 minutes travel time from patient’s residence to doctor’s office;
  • Basic hospital service – 60 minutes travel time from patient’s residence to hospital;
  • Other medical service – 90 minutes travel time from patient’s residence to site.
When applying for WVCHIP, please provide the following information in order for the WVDHHR to determine if you qualify for the non-accessible rule: Name of insurance company, policy number and telephone number.