Member Resources

Important changes to your children’s CHIP eligibility process

Important changes have been made to the CHIP program due to guidance from the federal government. These changes are intended to ensure CHIP families maintain access to health care.

Read DHS's notice and FAQ.

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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
Aviso de prácticas de privacidad de UPMC for Kids
Pennsylvania Department of Human Services’ Notice of Privacy Practices
UPMC for Kids Member Rights and Responsibilities

Caring for Kids newsletter archive

Issue 1, 2024
Issue 1, 2023
Issue 1, 2022