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 Members

Q. Who can I call or where can I go to ask questions?

A. The toll-free helpline welcomes calls from members and non-members. Please call 1-877-982-2447. Customer service representatives are available to take your call during the following hours:

The WVCHIP Helpline operates: Monday - Friday 8AM to 8PM. (TDD and Translation Services Available).

You can also go to the closest primary care center in your area. Staff at these sites can answer questions and help families complete applications. Click here to find a center near you.

Q. How long does my child’s coverage last?

A. Your child’s coverage lasts for 12 months, unless your child turns 19 or gets other health coverage (including Medicaid) during that time. Children are only eligible for WVCHIP through the end of the month they turn 19. For example, if your child’s birthday falls on August 1, they are covered until August 31. If your child gets other insurance, please call the DHHR change center at 1-877-716-1212 to cancel your WVCHIP coverage.

Your child’s health coverage begins the first day of the month in which the application was approved.

Q. Are there annual enrollment fees or deductibles?

A. No.

Q. Are there co-payments required for certain services and prescriptions?

A. Yes.  Click here for a list of co-payments.

Q. What doctors and dentists are in my area?

A. Providers do not have to a member of WVCHIP to provide services to a child who has health coverage through WVCHIP. They only need to accept the reimbursement amount or rate provided by WVCHIP. To ensure that a doctor or dentist accepts WVCHIP, you will need to contact their office directly, or you may go to InsureKidsNow to see a list of participating dentists.  Check here to find a provider in your area:  http://providerlookup.healthsmart.com/PEIA.


Q.When should I take my child to the Emergency Department?

A. Whenever your child is sick or injured, you need to decide how serious the problem is and how soon to get medical care.  Click here to read an article on helping you choose whether it is best to call your doctor, go to an urgent care clinic, or go to an emergency department right away.  


Q. How can I understand my child’s insurance card?

A. Call HealthSmart at 1-800-356-2392 for an explanation on any part of your child’s insurance card.

Q. I lost my child’s insurance card, what do I do?

A. Call HealthSmart at 1-800-356-2392 to replace a lost card.

Q. Do I need to renew my child’s coverage?

A. Yes. WVCHIP will send you a reminder to renew and a request for current income information when your child’s year of coverage is almost over. Do not forget to renew at this time so that there is no break in your child’s coverage.

Q. My income has changed. What do I do?

A. You do not need to report income changes since your child's insurance is good for 12 months.  During the 10th month of coverage, you should receive a renewal form and you can notify CHIP of any income changes at that time.

Q. I have other insurance for my child through my job now. What do I do?

A. Children covered by other insurance cannot also be covered by WVCHIP.  Please call the DHHR change center at 1-877-716-1212 to report the new coverage. We can cancel your WVCHIP coverage the day before your new coverage starts so that your child does not go without coverage at any time.

Q. I just had a baby and I want to add him/her onto WVCHIP. How do I do this?

A. Please call the DHHR change center at 1-877-716-1212 to report the change in your family's number of household members.

Q. I moved. What do I need to do?

A. Please call the DHHR change center at 1-877-716-1212 to give us your new address and other contact information.  You can also submit the changes online if you wish to do so by clicking here which will take you to the webpage where you can submit the changes.

Q. I am getting a bill because a claim is not being paid. Do I have to pay this?

A. Please call WVCHIP’s third party administrator, HealthSmart at 1-800-356-2392 to speak with someone about your claim.

Q. My child is going to college in the fall. Is he or she still covered?

A. Your child will only be covered by WVCHIP until he/she turns 19 (Coverage actually ends on the last day of the month in which your child turns 19).

Q. Are there benefit limits for some special services?

A. Yes, coverage for services beyond limits listed below is not provided without prior review for medical necessity.

 

Medical Necessity Review Required Beyond These Limits
Type of Service
Benefit Limit
Mental Health
26 visits
Chiropractic Services    

20 visits

Occupational Therapy            

20 visits

Physical Therapy    

20 visits

Speech Therapy    

20 visits

Vision Therapy    

20 visits

Primary Care    

26 visits

Specialty Care    

26 visits

 
Q. What do I need to do if my child needs medical service outside West Virginia?


A. You must call ActiveHealth at 1-800-356-2392 to get prior approval that the medical claim will be paid.

Q. Do I need to file claims for medical or prescription services?

A. Usually medical claims for a child covered by WVCHIP will be filed by the healthcare provider. If you need to file a medical claim, use the WVCHIP medical claim form and mail the completed form and a copy of the itemized bill to:

HealthSmart
PO Box 2451
Charleston, WV 25329-2451

If you get your child’s prescription filled at a pharmacy that participates with Express Scripts, Inc., your claim will be filed electronically for you by the Pharmacist. Most national drug stores and supermarket chains participate in the network. To find out if the pharmacy you use is a member of the network, you may call member services at 1-877-256-4689. If you are using a non-network pharmacy, you will have to pay for the full-cost of the prescription at the time it is purchased. To be fully reimbursed, you must submit a prescription claim form along with a receipt or itemized bill. The completed form should be mailed to:

Express Scripts, Inc.
PO Box 390873
Bloomington, MN 55439-0843

Q. Who do I contact about pre-certification or pre-authorizations?

A. Call ActiveHealth at 1-800-356-2392.

Q. Who do I contact about drug interactions or drug comparisons?

A. Call Express Scripts, Inc. at 1-800-824-0898

Q. What happens to WVCHIP coverage when a child moves out of state?

A. It is the parent’s responsibility to report this information to the DHHR change center at 1-877-716-1212. The child will lose coverage in this state and must reapply in their new state. Claims will not be paid for non-state residents.  Click here for a list of other state programs.

For more information about benefits, click here for the Summary Plan Description (SPD) and WVCHIP's Notice of Privacy Practices.

WVCHIP Insurance Card - New Cards for WVCHIP members

Cards have been renamed WVCHIP Gold; WVCHIP Blue, and WVCHIP Premium.  These cards have the medical benefits and prescription benefits listed on the back of the cards. 

Your insurance card will come separately in the mail within a few weeks of receiving your welcome kit. It will look like one of the mock-ups shown below and you may want to check to see that the name is shown correctly.

Click here  to see Examples of the Member Cards for the three levels of WVCHIP:  Gold, Blue and Premium.

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