How do I get a CHIP application?

There are two (2) ways to obtain a CHIP application:

	You can download and print the application in a PDF format. The application must be completed and mailed to us along with the income verification and the signature page in order to process the application.
	OR
	You may call 1-800-822-CHIP (2447) to request an application be sent to you.

How do I complete the application?

	Complete one application, which will cover all children under 19 years of age living in the household.
	Be sure to answer all questions. An incomplete application will delay processing.
	Include appropriate income documentation. An application that is submitted without income documentation is considered incomplete.

How do I select a participating Aetna doctor/provider?

To select a participating Aetna doctor/provider, click on Find a Chip Provider.

Contact Us

If you have questions or would like more information, please call:

1-800-822-CHIP (2447); or
1-800-628-3323 (TDD number for the hearing impaired)

One of our Member Services representatives will be able to assist you.

For application assistance, a representative is available Monday through Friday from 8:00 a.m. to 4:30 p.m.