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Children's Health Insurance Program

CHIP > Resources > Member Resources

Member Resources

Member Announcement - Benefit Change Effective: July 1, 2023

Copayments for Medical and Dental Services Effective: July 1, 2023

Benefits List Effective: July 1, 2023

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

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