Governor Wolf Announces All CHIP Plans Will Provide Enhanced Benefits to Meet Affordable Care Act Requirements

August 20, 2015

Hershey, PA – Governor Tom Wolf today announced all CHIP health insurance plans will provide enhanced benefits to meet the minimum essential coverage requirements of the federal Affordable Care Act.  These added benefits will begin when new CHIP policies take effect December 1. This means no family will have to worry about paying a penalty or getting new insurance now that the entire program is meeting the requirements, regardless of whether Washington, D.C. decides to make changes to their standards again.

Gov. Wolf has already taken action to ensure that all CHIP full cost health insurance plans, those under which families pay the entire premium, now meet minimum essential coverage requirements of the Affordable Care Act. Gov. Wolf is committed to fighting for Pennsylvania families and achieving real victories in the face of Harrisburg gridlock.

“Currently, only CHIP policies where the families pay the entire cost of the premiums must meet these enhanced benefit requirements.  However, I believe it is important that all Pennsylvania children have access to the best health care possible, and so I am implementing this requirement to provide enhanced benefits for all 148,000 Pennsylvania children covered by CHIP,” Governor Wolf said. “We cannot leave our children’s health insurance coverage to the whims of Washington and that’s why Commissioner Miller and I worked to ensure all CHIP plans meet federal minimum coverage requirements.”

The Governor made his announcement at the Penn State Hershey Children’s Hospital, a leading children’s health care facility.  He was joined for the announcement by Insurance Commissioner Teresa Miller and hospital officials.

“My first day in office I confronted the news that families of 3,600 children in our CHIP full cost plans, where families pay the entire cost of the premiums, faced tax penalties for 2014 and 2015, because these plans did not meet the minimum essential coverage requirements of the Affordable Care Act,” Governor Wolf said.  “I acted immediately to get the federal government to provide hardship waivers for these families for 2014, and to give us time beyond the February 15 deadline to work with families and our CHIP insurers to bring 2015 plans into compliance.  I announced in June that all these health plans now meet the federal requirements, and the families are eligible to apply for an exemption from tax penalties for the first half of 2015.  These families also have not faced any premium increases for their coverage during the current policy year.”

While solving the immediate problem of the potential tax penalties for families in the full cost CHIP plans, bringing these plans up to minimum essential coverage standards created a situation where all children in CHIP did not have access to the same level of benefits.

“Many of the added benefits required by the Affordable Care Act are important for children’s health, and because of Governor Wolf’s commitment to improving access to health care in Pennsylvania, all children in CHIP will now have these benefits,” Insurance Commissioner Teresa Miller said.

Among the added benefits that will become available in all CHIP plans are a prohibition on annual and lifetime dollar limitations for specific services classified as essential health benefits, including durable medical equipment, hearing aids, pediatric vision and dental service, including orthodontic services.  Prior to the minimum essential coverage requirements there were limits such as $1,500 per year for dental and orthodontic care, $5,000 per year for durable medical equipment, and $120 per year for glasses.

In addition, many preventive care services must be provided without cost sharing, such as co-payments, coinsurance, or deductibles.  Among these services are plaque control programs, oral hygiene education, dietary instruction, and prescribed iron supplementation.  And, health plans must provide parity between mental health/substance abuse benefits and medical/surgical benefits.

CHIP provides health insurance to children under age 19 who don’t qualify for Medical Assistance.  Currently, more than 148,000 Pennsylvania children are enrolled in the program.  CHIP is open to all children under age 19 regardless of family income.

For more information, visit, or call 1-800-986-KIDS.


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