2025 Income Guidelines & CoPays
2025 CHIP Information Flyer
HIPAA_Medical Release Form
Link for Information to be able to Update Your Address
Telehealth Policy
COVID-19 Vaccination Info for those age 12 years and older
Health Insurance - Family Application
Health Insurance - Single Streamlined Application
Summary Plan Description
Current WVCHIP Preferred Drug Formulary
Express Scripts (ESI) Prescription Claim Form
Notice of Privacy Statement
Emergency Room Use
Dental Procedure Codes
Maternity Coverage
Member Announcement - Benefit Change Effective: July 1, 2023
Copayments for Medical and Dental Services Effective: July 1, 2023
Benefits List Effective: July 1, 2023
