Resources

The following WVCHIP resources are available to be printed.  Just click on the item you want below:

English Versions

Health Insurance - Family Application
Health Insurance-Single Streamlined Application
Income Guidelines and CoPays - New March 2018
Summary Plan Description (SPD) (July 2018- June 2019)     
Medical Home Selection Form  
Current WVCHIP Preferred Drug Formulary
cvs_caremark_prescription_claim_form.pdf
Medical Claim Form
Prevention Brochure    
WVCHIP Information Flyer
WVCHIP Poster     
WVinROADS Poster    
Notice of Privacy Practices   
Kindergarten Screening Report
Non-State Agency List (Buy Into PEIA) 
WVCHIP Generic Flyer 
Antipsychotic Medicines for Children and Teens
Mental Health & Substance Use Disorder Benefits

HealthCheck/"School-Ready" Flyers
Overall Health:  Healthy Check Up Flyer
Hearing:           Ears To Hear Flyer
Vision:              Healthy Pair of Eyes Flyer
Oral Health:       A Healthy Smile Flyer



Request for Promotional/Literature Items
WVCHIP promotional items are available for use in community outreach activities.  If you work with an organization, etc. that serves or interacts with families who may be eligible to participate in WVCHIP, you can order printed materials to promote WVCHIP free of charge. Please click on the order form below.      

WVCHIP Literature Order Form