Utah CHIP Benefits at a Glance
For benefit details including co-pay amounts (the portion of the cost you pay for some services), please read your Member Handbook or call Member Services at (888) 483-0760.
| List of Covered Services | List of Non-Covered Services |
|---|---|
| Abortions and sterilizations (if criteria is met, with required forms) | Abortions, except to save mother’s life or result of rape or incest, with required forms |
| Ambulance, ground and air for medical emergencies | Acupressure |
| Applied Behavior Analysis (ABA) for the treatment of Autism Spectrum Disorder (ASD) | ADHD |
| Approved clinical trials | Allergy tests and treatment, selected types |
| Diabetes, to help educate Dialysis for end stage renal disease | Anesthesia, general, while in doctor’s office |
| Doctor visits, including specialists | Biofeedback |
| Drugs prescribed by your doctor | Birthing centers and home childbirth |
| Eye exams | Cancer therapy, neutron beam |
| Emergency care, seven days a week, 24 hours a day | Certain drugs and medicines (such as weight loss drugs, non-FDA drugs, etc.) |
| Family planning | Certain immunizations (anthrax, BCG, plague, typhoid yellow fever, and others) |
| Having a baby, including high-risk services | Certain pain services |
| Hearing exams | Charges/services not for medical purposes |
| Home health | Chiropractic services |
| Hospice (end-of-life care) | Claims after one year |
| Hospital services, inpatient and outpatient | Conditions caused by crime |
| Immunizations | Dental anesthesia unless criteria is met |
| Labs and X-rays | Device to correct or support the foot |
| Treatment for miscarriage (losing your baby due to natural causes) | Dry needling |
| Medical equipment and supplies | Experimental services |
| Mental health services | Eye surgery for vision (such as LASIK) |
| Occupational therapy | Family planning (specifically Norplant, infertility drugs, in-vitro fertilization, genetic counseling) |
| Organ transplants (bone marrow, heart and lung, pancreas and kidney, cornea, heart, kidney, liver, lung) | Fitness training, exercise equipment, fees for gym, etc. |
| Physical therapy | Food-based treatment |
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Gene therapy |
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Genetic counseling |
Prior Authorization
Some services must be approved before they will be paid. Permission to receive payment for that service is called Prior Authorization. Prior Authorization is needed for:
- Hospital/outpatient stay (non-emergency)
- Surgery
- Some office procedures
- Some x-rays and lab tests
- Home health care
- Medical equipment and supplies
- Long term care (nursing home or rehab)
- Physical, occupational, and speech therapy (Approval is needed after 12 combined visits per calendar year)
Updated April 30, 2024