Where can I get an application?
- Download an application. Be sure to print your completed application. (en Español)
Note: For information on filling out the application, refer to the KCHIP Application Process Training Presentation.
- Call toll-free (877) KCHIP18 (877-524-4718) to request an application.
- Pick up an application at any local health department, doctors' offices, hospitals, pharmacies and schools.
- Request an application packet online.
For help filling out your application, call toll-free (877) KCHIP 18 (877-524-4718).
Mail completed applications to:
PO Box 55270
Lexington, KY 40555-5270
Or fax your application to (859) 246-2890.
If you prefer, visit your local Department for Community Based Services Office to apply for KCHIP. Be sure to take all required information and documentation with you.
What do I need to apply?
Proof of income.
Provide copies of pay stubs for the last two months or a letter from your employer stating your wages, your employer's name, address, phone number and an original signature. If you are self-employed, send a copy of your last income tax return.
If you receive unearned income, provide the most recent award letter or other proof of the amount of your unearned income. Examples of unearned income include: KTAP, disability, pension, child support, alimony, cash gifts, annuities, interest, Social Security, veteran's benefits, etc.
If you receive child support, include copies of checks and a statement from the non-custodial parent or the child support collection agency in your county
Proof of expenses for child care or disabled adult living in the home.
Send copies of receipts or a statement from your child care provider.
Health insurance information.
If anyone in your family has health insurance that pays for doctor's office visits and hospital care, please provide:
- Name of the insurance company
- Group number and policy number
- Effective date
- Name of policy holder
- Names of people who are covered
Proof of citizenship
For children born outside Kentucky, provide a birth certificate, U.S. passport, adoption papers or other proof of citizenship. You can request birth certificates from state vital records offices.
Proof of identity
All applicants must provide proof of identity, such as:
- Copy of current state driver's license
- School photo ID
- Military dependant ID
- ID issued by state, federal or local government with photo
If you do not have these documents or the child is younger than 16, you may provide other acceptable proof of identity such as:
- School record including report card
- Day care or nursery school record
- Health clinic, doctor or hospital record
If you are unable to provide any of these documents, you may sign the attestation section on the application.
FAQ About Applying
How often do I renew KCHIP for my children?
You will receive a KCHIP renewal form in the mail every year.
To renew your child's KCHIP benefits, complete, sign and return the renewal form or complete a telephone interview and provide:
- Proof of income for the prior two months.
- Proof of unearned income. Examples of unearned income include: KTAP, disability, pension, child support, alimony, cash gifts, annuities, interest, Social Security, veteran's benefits, etc.
- Proof of child care expenses or disabled adult living in your home.
- Health insurance information.
Be sure to send complete information about earned and unearned income and health insurance. Failure to provide complete information could result in loss of benefits or prosecution for fraud.
KCHIP will contact you with a reminder if a completed renewal form for your child is not received by the date printed on your notice. If the form is not received within 30 days following that date, your child's KCHIP coverage will stop. To restore lost benefits, you may need to complete a new application. Your local DCBS office can explain how to restore lost benefits.
What do KCHIP health care cards look like?
Each KCHIP member receives a white wallet-size plastic card. Keep this card as long as you receive KCHIP benefits.
How do I use my KCHIP card?
Always take the card with you when your child receives health care services to avoid having to pay for the service. Don't ever let anyone else use your child's card. If you lose your child's card, contact your caseworker.
What is Passport?
Passport is the name of the KCHIP program serving children in Jefferson and surrounding counties. Children served by Passport will also receive a white wallet-sized plastic Passport card when they are enrolled in KCHIP. Be sure to bring both your Passport and KY Health Card when your child receives health services.
For further information on the Passport Health Plan, refer to the member handbook.