Member Resources

Important changes to your children’s CHIP eligibility process

Starting April 17, 2023, the Pennsylvania Department of Human Services (DHS) began determining eligibility for CHIP applications and renewals. DHS now handles all communications related to eligibility and application/renewal processing.

Read DHS’s notice and FAQ about these changes.

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Documents you may need

On this page you can find electronic copies of many UPMC for Kids resources, including documents, forms, and more. If you would like printed copies instead, please call a Health Care Concierge at 1-800-650-8762 (TTY: 711).

Benefits

Member Handbook
Summary of Benefits Booklet
Exclusions Booklet
Pharmacy Benefits Booklet
Explanation of Benefits Tutorial
Invoice Tutorial

Eligibility

Application Form
Renewal Form
Income Guidelines Chart

Reimbursement forms

Prescription Drug Claim Form
Out-of-Network Care Claim Form
Flu Shot Reimbursement Form

Member rights and privacy

Personal Representative Designation Form
Member Authorization to Use or Disclose Protected Health Information
Privacy Statement
UPMC for Kids Notice of Privacy Practices
Pennsylvania Department of Human Services’ Notice of Privacy Practices
UPMC for Kids Member Rights and Responsibilities

Caring for Kids newsletter archive

Issue 1, 2023
Issue 1, 2022
Issue 2, 2021