CHIP > Resources

Resources

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

Income Guidelines and Co-Pays

Health Insurance - Family Application

Health Insurance-Single Streamlined Application

Summary Plan Description (SPD) (July 2019- June 2020)

Medical Home Selection Form

Current WVCHIP Preferred Drug Formulary

cvs_caremark_prescription_claim_form.pdf

Medical Reimbursement Form

Prevention Brochure

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