Bridge to Benefits - SD - Children's Health Insurance Program (CHIP)
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Children's Health Insurance Program (CHIP)
 
  1. What is the Children's Health Insurance Program (CHIP)?
  2. Who can get CHIP?
  3. How does CHIP work?
  4. What services are covered by the CHIP?
  5. Does CHIP cover travel expenses for medical treatment?
  6. What if my child has special health needs?
  7. Do I have to be a US Citizen for my child to get CHIP?
  8. Does it matter how long I have lived in South Dakota?
  9. Are American Indian Children eligible even if they have Indian Health Services (IHS) coverage?
  10. What are Resources? Is there a resource limit for CHIP?
  11. How do I get an application?
  12. Do I have to go in person to apply?
  13. Are there co-payments (co-pays)?
  14. How often do I need to renew coverage for CHIP?
  15. How soon will my child/children hear if they are accepted on CHIP?
  16. What do I do when I cannot find a dentist who will accept Children's Health Insurance patients?

1. What is the Children's Health Insurance Program (CHIP)?
CHIP is an insurance program for low- to moderate-income, uninsured children.  It is also known as the State Children’s Health Insurance Program (SCHIP).

2. Who can get CHIP?
CHIP provides health insurance coverage to children under age 19 whose family income is up to 200% of Federal Poverty Level (which amounts to $44,100 per year for a family of four in 2009).

3. How does CHIP work?
If you are eligible for CHIP services, you will receive an identification card. You must show your ID Card before receiving any medical services. You should carry your card with you at all times. Failure to present your identification card is cause for payment denial. Payment for denied services may then be your responsibility.

As a CHIP participant, you must choose a Primary Care Provider (PCP), which is the doctor or clinic chosen by you or assigned to you to oversee your medical needs.  Your Benefit Specialist will provide this list for you; you can choose one in your area or have one assigned to you. Along with this list, you will find a selection form for you to complete and return to your caseworker.

When you receive a service covered by a provider (doctor, hospital, etc.), the provider submits a bill to the state for payment. The provider is paid directly. When the program makes payment for a covered service, that particular service is considered paid in full. The provider cannot bill any remaining balance of a covered service to you, your family, your friends or the county.  If the service is not covered by the program, you may be responsible for payment in full. Your provider can tell you whether a service is covered.

4. What services are covered by the CHIP?
Children who are eligible are entitled to full Medical Assistance coverage and Well-Child Care Exams. The program may go back and cover medical services a child received three months prior to applying for CHIP. The start of medical coverage is based on the date the application is received by DSS.

CHIP covers:

  • Doctor Appointments
  • Hospital Stays
  • Dental and Vision Services
  • Prescription Drugs
  • Mental Health Care
  •  Click here to review the Department of Social Services complete list of covered services.

5. Does CHIP cover travel expenses for medical treatment?
You can be reimbursed for non-emergency medical transportation for things like mileage, lodging and meals. Transportation must be to the closest medical facility or medical provider capable of providing the necessary services. The service must be a Medicaid covered service provided by a medical provider who is enrolled in the South Dakota Medical Assistance Program.

You will not be reimbursed for travel within your city limits and you will not be reimbursed for medical trips to see your Primary Care Provider.

6. What if my child has special health needs?
If your child has a chronic health condition, Children’s Special Health Services may be able to help.

  • Call 1-800-738-2301 for more information.

7. Do I have to be a US Citizen for my child to get CHIP?
To qualify you must be a US Citizens, National  or qualified alien.

8. Does it matter how long I have lived in South Dakota?
No, but you must be a current resident of South Dakota.

9. Are American Indian Children eligible even if they have Indian Health Services (IHS) coverage?
Yes.

10. What are Resources? Is there a resource limit for CHIP?
Examples of resources are money in a bank account, bonds, stocks, certificates of deposit, real property and other things of value that you and your family own.   There is no resource limit for the Child Health Insurance Program.

11. How do I get an application?
CHIP applications are available at all Social Services Locations, and many schools, clinics and hospitals.  You can also Download and print CHIP Application from the SD Department of Social Services website.

To complete the application:

1. Read the application form carefully and answer each question completely.

2. If you need help completing or understanding this form, contact the Department of Social Services Field Office  closest to where you live.  If you would like an interview, you may request one.

3. Provide proof of income, insurance, and daycare or child support expenses; copies of these documents are acceptable. Proof of identity and citizenship is also required for all individuals requesting medical assistance; original documents required.

4. Sign and date the application form. (If two parents are in the home, both must sign)

5. Mail, Fax, or take the application form to your local Social Services Office. A determination will be made within 45 days from the date your application is received.

When completing the application, keep in mind that:

  • If a member of your family receives Social Security Income DO NOT count them in the family size and DO NOT count their income.
  • Earnings of a child (under age 19) are not counted if living with a parent or other adult caretaker.
  • Most student loans or grants are not counted as income.
  • The start date of medical coverage depends on the date the application is received by the Department of Social Services.
  • Medical coverage may go back 3 months prior to the application date.
  • Send proof of all income and expenses from the last 30 days along with the application. Also, send proof of expenses for child support paid and child care paid while working.
  • The fifth paycheck, if paid weekly, or the third paycheck, if paid every other week, is NOT counted.

If you need assistance filling out the application or have questions, contact your local DSS office. For more information, you can also call 1-800-305-3064.

12. Do I have to go in person to apply?
No, you can print off an application, or request to have one mailed to you, and send it in to your local Department of Social Services Office.

13. Are there co-payments (co-pays)?
No, there are no co-pays for covered services. 

Children who already have private health insurance may also be eligible for CHIP paying deductibles, co-payments and other medical services not covered by their private policy.

14. How often do I need to renew coverage for CHIP?
Individuals do not need to reapply; their case is reviwed at least once per year.

15. How soon will my child/children hear if they are accepted on CHIP?
A determination will be made within 45 days from the date your application is received.  The start of medical coverage is based on the date the application is received in the DSS office.

16. What do I do when I cannot find a dentist who will accept Children's Health Insurance patients?
If you have trouble finding a dentist who accepts the Children's Health Insurance Program patients, please call Delta Dental at 1-800-627-3961 for further assistance in finding a dentist to help you and your child.