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 Co-Payment Information

The WVCHIP Plan has three levels of copayment participation.  All Children insured under the Plan particiate in some level of cost share (copayments and premiums), *except for those children registered under the federal exception for Native Americans or Alaskan Natives.  Members must present the WVCHIP card at the time medical, dental or prescription drug services are provided.  Cost share participation has three levels referred to as enrollment groups:  

WVCHIP Gold

Copayments are required for non-medical home office visits, and covered brand name prescription drugs.

WVCHIP Blue

Copayments are required for non-medical home office visits, hospital inpatient and outpatient services, emergency room visits, and covered brand name prescription drugs.

WVCHIP Premium Plan

Copayments are required for non-medical home office visits, some dental services, hospital inpatient and outpatient services, emergency room visits, and covered brand name prescription drugs.  In addition, monthly premium payments are required for continued participation. Coverage begins the first day of the following month after payment is received. 

Copayment Maximums

The maximum copayment amounts that may be required during a benefit year are listed on the lower right corner of the following chart: 

Income Guideline/CoPays Chart

*Federal regulation permits the exemption of Native American/Alaskans from copayments. Click here for a list of federally recognized tribes.

Click here for the WVCHIP Drug Formulary.

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