Premiums and Cost Sharing

What are copayments?

Copayments are the amounts that a member is required to pay when getting certain CHIP covered services. You must pay the copayment at the time a health-care service is received. These can be different based on family income and the kind of service. Some services do not have copayments like well-child or well-baby visits or immunizations (shots). No copayments are paid for preventive care and pregnancy-related services. Your child’s Dell Children’s Health Plan ID card lists the copayments that apply to your family situation. Present your child’s ID card when you get office visit services or have a prescription filled. You do not have to show your child’s ID card before he or she gets emergency care. If the cost of a covered service is less than the member’s copayment, the member will be required to pay no more than the cost of the covered service.

How much are they and when do I have to pay them?

The following table shows the CHIP copayment schedule according to family income. Enrollment fees and copayments do not apply for CHIP Perinate Newborn members and CHIP members who are Native Americans or Alaskan Natives.

What are CHIP cost-sharing caps?

The member guide you received from CHIP when you enrolled includes a tear out form that you should use to track your CHIP expenses. To make sure that you do not exceed your cost-sharing limit, please keep track of your CHIP-related expenses on this form. The enrollment packet welcome letter tells you exactly how much you must spend before you are eligible to mail the form back to CHIP. If you have misplaced your welcome letter, please call CHIP at 1-800-647-6558, and they will tell you what your annual cost-sharing limit is. When you reach your annual cap, please send the form to CHIP, and they will notify Dell Children’s Health Plan. We will send you a new member ID card. This new card will show that no co-payments are due when your child gets services.