CHIP
Children ages 0 through 18 |
| Monthly cost |
$0 for Free CHIP
$25.00, $40.00, or $50.00 per month per child for Low-Cost CHIP
$215.22 per month per child for Full-Cost CHIP |
| Type of coverage |
Keystone Health Plan East HMO |
| Eligibility based on |
Family size and income |
| Wait period (if eligible) |
None |
| Pre-existing condition rule |
No |
| Copays |
$0 for Free CHIP
$5 PCP*/$10 specialist for Low-Cost CHIP
$15 PCP/$25 specialist for Full-Cost CHIP |
| Benefits |
| Doctor office visits |
$0 for Free CHIP
$5 PCP*/$10 specialist for Low-Cost CHIP
$15 PCP/$25 specialist for Full-Cost CHIP |
| Hospitalization |
limited to 90 days per year |
| Surgery and anesthesia |
covered |
| Emergency accident and medical |
$0 for Free CHIP, $25 for Low-Cost CHIP, and $50 for Full-Cost CHIP (waived if admitted) |
| Diagnostic services |
covered |
| Chemotherapy and radiation |
covered |
| Maternity care |
covered |
| Newborn care |
covered for up to 31 days following birth |
| Dental |
covered; no orthodontia |
| Vision and hearing |
covered; includes eyeglasses and hearing aids |
| Prescription drugs |
$0 for Free CHIP
$6 generic/$9 brand name for Low-Cost CHIP
$10 generic/$18 brand name for Full-Cost CHIP |
| Durable medical equipment (DME) |
covered |
| Mental health |
covered |
| Serious mental illness |
covered |
| Substance abuse |
covered |
