CHIP Co-pays and Cost Sharing
How much do I have to pay for my child’s dental care?
You must pay for:
- Non-covered or optional dental services that you choose to have done.
- Services that you have done more often than is allowed by the plan.
- Services given by a non-contracted dentist.
If your child gets services before their dental coverage starts, you must pay for them. You will also have to pay for services that:
- Covers dental treatment using the most cost-effective option.
- Regularly gives good professional practice.
- Is limited to the benefit level for the least costly, best alternative (you will be responsible for all charges that exceed covered dental benefit).
CHIP Members have a yearly maximum of $564 (per 12-month term of coverage). CHIP members must pay a co-payment for each dental visit when non-preventive services are given, unless the member’s cost sharing has been met. A list of non-preventive services is listed at the top of this page. Co-pays do not apply to initial and periodic exams, x-rays, cleanings or sealants.
- Are non-covered services.
- Exceed the benefit limits.
Co-Pays are based on the Federal Poverty Level (FPL). The federal government sets the FPL every year. Below are examples of the co-pay that is set for each level. Your Member ID Card will tell you what co-pay you will need to pay for each non-preventive visit.
|Federal Poverty Level*
||Office Visit Co-Pay**
|At or below 151% FPL
|Above 151% up to and including 186% FPL
|Above 186% up to and including 201% FPL
* The federal poverty level (FPL) refers to yearly income defined by the federal government.
** CHIP members must pay an office visit co-payment for each non-preventive dental visit.
Contact the DentaQuest Member Call Center for information about benefit limits and frequency toll-free at 1-800-508-6775.
How much do I have to pay for services not covered by the CHIP Dental Program or services that are over the yearly maximum?
Members do have to pay for services that are:
- Non-covered services.
- Non-preventive services given after the member has reached their yearly maximum.