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CCC H I P I N AW S I LV E R L A K E M E D I C A L F O R MNameHome Address Page 1 & 2 are to be filled out by parents. Page 3 & 4 to be filled out by physician and returned to our office by May 15th.

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What is c h i p?

CHIP stands for Children's Health Insurance Program.

Who is required to file c h i p?

Parents or legal guardians of eligible children are required to file for CHIP.

How to fill out c h i p?

You can fill out the CHIP application online, by mail, or in person at your local Medicaid or CHIP office.

What is the purpose of c h i p?

The purpose of CHIP is to provide health insurance coverage to children in low-income families who do not qualify for Medicaid.

What information must be reported on c h i p?

You must report information about your household income, number of family members, and any other health insurance coverage.

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