WVCHIP benefits

WVCHIP, or West Virginia’s Children’s Health Insurance Program (WVCHIP), covers children under 19 and pregnant members who meet certain income guidelines.

Medical care is just the beginning

With Wellpoint, you have access to a wide range of services including dental and vision care, mental health services, and extra benefits to help you live well.

We’re here to help you or your child have the best care. To help with this, there are no copays for behavioral health and emergency services. Some other services may need a small copay. Your WVCHIP benefits include:

Primary care provider (PCP) visits
Immunizations (shots)
Wellness visits
Early and Periodic Screening, Diagnosis and Treatment (EPSDT) services for members under 21.
Specialist visits
Urgent and emergency care
Hospital care
Lab and X-ray services
Pregnancy services
Family planning
Chiropractic services
Physical and occupational therapy
Speech and hearing services
Behavioral healthcare (mental and substance use disorder (SUD) services)
Home healthcare services
Disease management for asthma, diabetes, and other conditions

Find care

A prior authorization is when your primary care provider (PCP) needs to ask us to approve a service, or get an ‘OK’, from us before you have it. Your PCP will work with us to get the prior authorizations you need. If you need tests or a specialist, your PCP will help you get this care. This is called a referral. If you’re unsure what you need approvals or referrals for, check the referrals and prior authorizations page for more information.

Healthy Rewards is a program that pays you for taking control of your health. You can earn rewards for:

Taking your child or teen to their wellness visits.
Quitting smoking.
Going to prenatal and postpartum visits.
Getting diabetic screenings.
And other healthy activities.

You can redeem your Healthy Rewards on the Benefit Reward Hub, and review how to earn rewards on the Healthy Rewards page. To learn about other extra benefits, visit the extra benefits page.

Your Costs

Premiums

WVCHIP members in the Premium Plan pay a monthly payment, called a premium. You can make your payment online on the WVCHIP Premium Plan Payment System.

Copays

Copays are a set dollar amount you pay for a covered service like a medical visit or prescription refill. Copay amounts vary based on which WVCHIP plan you or your child is in.

Copays

Medical services and prescription benefits	Gold	Blue	Premium Plan
Generic prescriptions	No copay	No copay	No copay
Listed brand prescriptions	$5	$10	$15
Non-listed brand prescriptions	Full retail cost	Full retail cost	Full retail cost
Medical home or well-child physician visit	No copay	No copay	No copay
Doctor visit (non-medical home)	$5	$15	$20
Hospital/inpatient services	No copay	No copay	No copay
Outpatient surgical procedures	No copay	$25	$25
Emergency room (Payment is waived if admitted.)	No copay	$35	$35
Dental services	No copay	No copay	$25 for some non-preventive services
Vision	No copay	No copay	No copay

Gold
Medical services and prescription benefits
Generic prescriptions	No copay
Listed brand prescriptions	$5
Non-listed brand prescriptions	Full retail cost
Medical home or well-child physician visit	No copay
Doctor visit (non-medical home)	$5
Hospital/inpatient services	No copay
Outpatient surgical procedures	No copay
Emergency room (Payment is waived if admitted.)	No copay
Dental services	No copay
Vision	No copay

Blue
Medical services and prescription benefits
Generic prescriptions	No copay
Listed brand prescriptions	$10
Non-listed brand prescriptions	Full retail cost
Medical home or well-child physician visit	No copay
Doctor visit (non-medical home)	$15
Hospital/inpatient services	No copay
Outpatient surgical procedures	$25
Emergency room (Payment is waived if admitted.)	$35
Dental services	No copay
Vision	No copay

Premium Plan
Medical services and prescription benefits
Generic prescriptions	No copay
Listed brand prescriptions	$15
Non-listed brand prescriptions	Full retail cost
Medical home or well-child physician visit	No copay
Doctor visit (non-medical home)	$20
Hospital/inpatient services	No copay
Outpatient surgical procedures	$25
Emergency room (Payment is waived if admitted.)	$35
Dental services	$25 for some non-preventive services
Vision	No copay

Maximum copays allowed

Number of members copay maximums	Gold	Blue	Premium Plan
One (1) member medical maximum	$150	$150	$200
One (1) member prescription maximum	$100	$100	$150
Two (2) children medical maximum	$300	$300	$400
Two (2) children prescription maximum	$200	$200	$250
Three (3) children medical maximum	$450	$450	$600
Three (3) children prescription maximum	$350	$300	$350
Dental services	Does not apply	Does not apply	$150 per household

Gold
Number of members copay maximums
One (1) member medical maximum	$150
One (1) member prescription maximum	$100
Two (2) children medical maximum	$300
Two (2) children prescription maximum	$200
Three (3) children medical maximum	$450
Three (3) children prescription maximum	$350
Dental services	Does not apply

Blue
Number of members copay maximums
One (1) member medical maximum	$150
One (1) member prescription maximum	$100
Two (2) children medical maximum	$300
Two (2) children prescription maximum	$200
Three (3) children medical maximum	$450
Three (3) children prescription maximum	$300
Dental services	Does not apply

Premium Plan
Number of members copay maximums
One (1) member medical maximum	$200
One (1) member prescription maximum	$150
Two (2) children medical maximum	$400
Two (2) children prescription maximum	$250
Three (3) children medical maximum	$600
Three (3) children prescription maximum	$350
Dental services	$150 per household

Visit chip.wv.gov to learn more about your potential copays or call the WVCHIP Helpline at 877-982-2447.

Your Care Plan

If you’re a Wellpoint case management member, you have a Care Plan. The Care Plan can help you:

Stay connected with your care coordinator.
Access your care coordinator’s phone number and email.
Send secure messages about diagnoses, goals, medicines, and services.
Check your goals.
Review the due dates of your goals.

Go to Your Care Plan

The member handbook: Everything you need to know

Your member handbook is your go-to guide for health services. Read it to find out about:

How to use your benefits.

How to choose a primary care provider (PCP).

How to get help if your PCP’s office is closed.

How to reach the Customer Care Center if you have questions.

Your rights and responsibilities as a Wellpoint member.

Review the WVCHIP member handbook (English)

Want to switch to Wellpoint?

You can request to switch to Wellpoint if you’re currently in another WVCHIP health plan. Just call Mountain Health Trust at 800-449-8466 (TTY 304-344-0015) or visit their website. You can also check the eligibility and enrollment page to get started.