CHIP Plan

Understanding Copays

For Your Child’s Care.

Some services require a copayment (copay) that you pay directly to the provider each time your child receives care. Copay amounts depend on if your child is part of the free, low-cost or full-cost CHIP premium categories.

There are no copays for preventive care services, including well-child visits and visits for vaccinations, for all Health Partners Plans CHIP members.

Father storytelling, child reading

Copays for Services

There are no copays for any services for members enrolled in the free program. If your child qualifies for the low-cost premium category, the maximum amount you will pay for copays annually is 5% of your family income.

Father storytelling, child reading

All copay amounts are listed below:

Type of Service Free Premium Low-Cost Premium Full-Cost Premium
PCP Visits (sick care) Copay $0 $5 $15
Specialist Visits Copay $0 $5 $15
Emergency Room Copay (waived if admitted) $0 $25 $50
Prescriptions Copay (Generic/Brand) $0 $6 / $9 $10 / $18
Mental Health or Substance Abuse Outpatient Visits Copay $0 $0 $0
Frequently Asked Questions

Copays are flat fees you pay for covered services like visiting the doctor or filling a prescription. With Health Partners Plans CHIP, there are no copays for preventive care services, including well-child visits and vaccinations. Copays for other services depend on premium category and can be found in the chart above.

Premiums are regular monthly payments you must make to keep your health care plan active. You must pay your monthly premium even if you don’t need medical services during a specific month.

Your child or teen may be eligible for Health Partners Plans CHIP if they are:

  • Younger than 19 years old
  • A U.S. citizen, a U.S. national, or a lawfully residing noncitizen
  • A resident of Pennsylvania
  • Uninsured
  • Not eligible for Medicaid

To check your child’s eligibility, visit dhs.pa.gov/COMPASS.

No family earns too much for a child to enroll in CHIP. There is no upper income limit. Your monthly premium will depend on your child’s age, family size, and family income. View the CHIP income guidelines chart to see where your family falls.

Health Partners Plans CHIP provides flexible payment options, including check and money order payments and recurring credit card and debit payments, to help make paying premiums as convenient as possible.

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