Benefit Limits and Services Not Covered

Program Exception Process 

For those services that have limits, if you or your child’s provider believe your child needs more services than the limits on the service allows, you or your child’s provider can ask for a program exception (PE).

To request a PE, before your child receives the service: 

1. Call Keystone First – CHIP Enrollee Services and tell the Enrollee Services representative that you want to ask for an exception to the benefit limits. 
2. You can mail or fax a written request to:
   
   Benefit Limit Exceptions
   Enrollee Services Department
   Keystone First – CHIP
   200 Stevens Drive
   Philadelphia, PA 19113-1570 
   Fax: 1-215-937-5367 
   
   
3. Your provider can call the Keystone First – CHIP Care Management department at 1-844-377-2447 (TTY 711). 

To ask for a PE after your child receives the service: 

1. You can call Keystone First – CHIP Enrollee Services and tell the Enrollee Services representative that you want to ask for an exception to the benefit limits.
2. Your provider can call Keystone First – CHIP Care Management 1-844-377- 2447 (TTY 711). 
3. Your provider can mail the request to the Keystone First – CHIP Provider Appeals department at:
   
   Keystone First – CHIP
   Clinical Provider Appeals Department
   P.O. Box 211352
   Eagan, MN 55121 

Services not covered

For a complete list of services that are not covered, please see the Enrollee Handbook. If you have questions about services not covered, please call Enrollee Services at 1-844-472-2447 (TTY 711).