How much do I have to pay for my health care?
You might have to pay a co-payment when you or your child gets certain covered services. Your ID card will list your co-payment amount.
What are Co-payments? How much are they and when do I have to pay them?
The table below lists the CHIP co-payment by the amount your family makes. Co-payments are paid to the doctor or drug store at the time of service. Remember to show your ID card when you have an office visit, go to the hospital or have a prescription filled.
To ensure that you do not exceed your cost-sharing limit, please keep track of your CHIP related expenses. The enrollment packet welcome letter has a tear off form to track your expenses. It also tells you exactly how much you must spend before you are able to mail the form back to CHIP. If you have misplaced your welcome letter, please call CHIP toll free at 1-800-647-6558 and they will tell you your yearly cost-sharing limit.
When you reach your yearly cap, please send the form to CHIP and they will tell us. We will issue a new Member ID card which will show that no co-payments are due when you/your child receive services.
Co-payments do not apply to CHIP Perinate newborn, CHIP Perinatal and CHIP Members that are Native Americans or Alaskan Natives. There are no co-payments for well-baby and well-child care services, preventative services or pregnancy-related assistance.
CHIP Perinatal Members do not have to pay the enrollment fee.
Cook Children's Health Plan is not responsible for payment of unauthorized non-emergency services provided to a CHIP Member by an out-of-network Provider. In such circumstances, the CHIP Member will be responsible for all costs.
Will I have to pay for services that are not covered?
If the service is not a covered benefit, then you will have to pay for the service. If you have any questions please call Member Services.
What if I get a bill from my doctor?
Your doctor should not bill you for a covered service. If you do get a bill from a doctor, call the doctor's office and make sure they have your CHIP information. All of the information your doctor needs to bill Cook Children's Health Plan for the service is on your/child's ID Card.
If you feel that you should not have received a bill or you need help to understand the bill, call Member Services. We will help explain the bill to you. We can talk to the doctor's office for you to explain your/your child's benefits. When you call us, please have your/child's ID card and the doctor's bill with you. We will need that information so we can help you.
We're here to help
Member Services is available Monday - Friday from 8 a.m-5 p.m. at 1-800-964-2247.