Income Guidelines.

For The West Virginia Children's Health Insurance Program.

Please Note the Annual and Lifetime Limits Below the Chart.

The following charts show the monthly (and annual) limit on family income:

Chart 1: Family Income Before Taxes no co-pay
Family Size Monthly Annual
2
$1,650
$19,800
3
$2,075
$24,900
4
$2,500
$30,000
5
$2,925
$35,100
6
$3,350
$40,200
7
$3,775
$45,300

Chart 2: Family Income Before Taxes with co-pay
Family Size Monthly Annual
2
$2,200
$26,400
3
$2,767
$33,200
4
$3,334
$40,000
5
$3,900
$46,800
6
$4,467
$53,600
7
$5,034
$60,400

MEDICAL CO-PAYS: $15 - $35 PER VISIT

Drug Co-Pays Only: $0 generics/ $5 brand/ (not covered) non-preferred.

Medical and Drug Co-Pays: $0 generics/ $10 brand/ (not covered) non-preferred.

 

New Preferred Drug List for WVCHIP Members

The West Virginia Children’s Health Insurance Program is changing to a new Preferred Drug List (PDL), effective January 1, 2006. Due to rising drugs costs a new drug list was created by focusing more on generic use to contain costs. Adoption of this change is estimated to bring a total savings of more than $1 million to the program. Unlike the current PDL, non-preferred drugs will no longer be covered. After this January 1, 2006 effective date, if a provider chooses to prescribe a drug not listed on the formulary it will be a 100% retail cost to the patient. Co-payments for drugs on the new PDL will remain the same. Click here for the new preferred drug list. Questions concerning drugs covered by WVCHIP should be directed to Express Scripts, Inc. (ESI) at 1-877-256-4689.  Click here to see a copy of the letter mailed out to WV CHIP families.

Click here (p.d.f) to see the new preferred drug formulary.

Please Note Below: Annual and Lifetime Limits

Income is counted for the child and only the following individuals if they are living in the home with the child: mother of the child, legal father of the child, and the legal spouse of the child.

Benefit Limit Amounts: Annual and Lifetime Limits

An annual and lifetime cap will be placed on total claims amounts for members with WV CHIP coverage. As of July 1, 2002, an annual limit of $200,000, and a lifetime limit of $1,000,000 has been placed on benefits, as passed by the CHIP Board of Directors. These caps will include all medical, dental and vision services combined. A letter will be sent to those members who have reached 75% of the maximum limitation to alert them in advance of reaching the cap.

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