Applying for CHIP
First
You need to gather all the information you will need to complete the application before you start:
- > Income amounts for your entire household before taxes - this includes income from employment and all other forms of income (for example - social security, pension, workers' compensation, unemployment, child support, etc.)
- > Social Security Numbers and birth dates for any children that will be included on the application
- > Day care expenses for your household (if any)
- > Work transportation expenses for your household (if any)
- > Private health insurance information (if you have or had private health insurance in the last six months)
How to get an application
There are five ways to apply for CHIP through Aetna Better Health Kids:
- > Complete an application online by going to the state's COMPASS website. Keep in mind you will need to send in your income documents to complete the application.
- > Download an application from the link below to print an application. This will require you to have Adobe Acrobat Reader installed on your computer to open and print file. Upon completion, please send the application with income documents to the address on the application or fax to 1-860-754-1055.
- > CHIP Application Forms
English
Español - > CHIP Renewal Forms
English
Español - > Request a paper application be sent to you by emailing a request to chipofpa@aetna.com. Include your name and mailing address in your e-mail.
- > Request an application to be mailed to you. Call 1-800-822-2447, TTY 1-800-628-3323.
- > Apply over the phone by calling 1-800-986-KIDS or TTY 1-800-628-3323.
Help with your application is available Monday through Friday, from 8 a.m. to 5 p.m.
To complete your application
- > One application will cover all children who are under 19 years of age and living in the same household.
- > Answer all questions. An incomplete application could delay processing and determination.
- > Include required income documentation. An application submitted without income documentation will be considered incomplete.
- > If there are requirements for other documentation that is needed to process your
application, it will be noted on the application. If you complete you application
online, you can send the additional information via mail or fax at the address below:
Aetna Better Health Kids - CHIP
P.O. BOX 14384
Lexington, KY 40512-4384
Fax 860-754-1055
Acceptable income documentation includes:
- > Employment - at least one of the most current pay stubs. If pay stubs are not available, your employer can provide a letter that indicates your gross income and how often you are paid. This letter should be on company letterhead. W-2s or other tax forms are not acceptable (except if you are self-employed - see below).
- > Unemployment Compensation - a copy of the most current check stub or award letter that indicates your weekly benefit amount. If you have access to a printer, you can print your last month's disbursements from the Department of Labor and Industry website.
- > Self-Employment - a copy of the most recent Federal Income Tax Return including all schedules associated with that tax return or a Profit and Loss Ledger of the most current period showing gross profit, expenses, and net profit (1099 Forms are not acceptable).
- > Dividends/Interest - a copy of the most current Federal Income Tax return, a copy of the most current 1099 tax form, or a statement from the financial institution.
- > Social Security - a copy of the Benefit Award letter or the most current SSA-1099 tax form. If you do not have a copy of the award letter, go online www.ssa.gov/onlineservices to request a one.
- > Pension/Retirement - a copy of the most current award letter or most current pay stub.
- > Child Support or Alimony - a copy of one of the most current check stubs, a bank statement, or the disbursement statement. If you have access to a printer you can download a copy of payments received last month from the Domestic Relations website.
- > Other - must have current documentation as proof of "other" income.
Income documentation must be from within the last 60 days, except in an instance where it is appropriate to send a tax form.
Income documentation must include any special circumstances regarding your income, please explain in detail on a separate sheet of paper.
If you are mailing, separately from the application, any income or other documentation needed please be sure to include your name or your child's name on the documentation.
Please be sure to send copies of the income documentation. Originals will not be returned.