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.
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