CHIP Policy

600 Program Benefits

Effective Date: June 1, 2025

Previous Policy

This section provides some general information about the type of services or benefits an enrollee may receive, and in some cases may describe some limits on certain services and the processes for obtaining certain services. Specific benefits covered by CHIP may change periodically as a result of action taken by the Department of Health and Human Services, State or Federal governments.

1. There are three benefit plans under CHIP. The plan is determined using the member's countable income and citizenship status. The benefits are the same under all plans, but the member's out of pocket costs are determined by which plan they are eligible to receive.
   • Plan B - For children whose countable income is up to 150% FPL.
   • Plan C - For children whose countable income is up to 200% FPL.
   • State CHIP - For children whose countable income is up to 200% FPL.
2. CHIP benefits are provided by Medical and Dental Plans (Accountable Care Organizations (ACO)) that contract with the Department of Health and Human Services.  The CHIP benefits and co-pays are the same under each plan, but providers and facilities may be different.  
3. Enrollees should contact the customer service number for the selected health or dental plan with specific CHIP coverage questions or refer to CHIP member guide for a list of facilities and which CHIP plans are accepted (601).
   • Members can access the CHIP member guide and co-payment summary online at:  www.health.utah.gov/chip/resourcematerials.htm.
4. CHIP covers the following benefits:
   • Well-child exams;
   • Immunizations;
   • Doctor visits;
   • Medical emergency services;
   • Prescriptions;
   • Health and visions exams;
   • Mental health services; and
   • Dental services.
5. Members can view their medical coverage and health plan information online using the MyBenefits lookup tool at www.mybenefits.utah.gov.
6. Incarcerated CHIP members who are in a participating facility are eligible for pre-release services.
   • Services include but are not limited to intensive case management, Medication-Assisted Treatment (MAT) services for all types of Substance Use Disorders (SUD), a 30-day supply of prescription medication upon release, lab and radiology services, targeted outpatient services, diagnosis and treatment of physical and behavioral health conditions, and screening for housing related services.