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How to Apply

Now available online - our new and improved CHIP application!

You can download a CHIP application, print it, fill it out and mail or fax it to us. Or fill it in right on your computer, print it, and send it to us.

CHIP
P.O. Box 202951
Helena, MT 59620-2951

Toll-free FAX: 1-877-418-4533

Please use black ink to fill out the application.

GO TO THE APPLICATION

To have an application mailed to you, call 1-877-543-7669. This is a free call or click here: Send Me an Application.

To get help filling out your application, call 1-877-543-7669.

Note: Downloading the application will require Adobe Acrobat Reader.
To download Adobe Acrobat Reader, click on the following link:

There is no current waiting list. When enrollment exceed the maximum spaces available, eligible children are placed on a waiting list. As children on the plan are disenrolled,* spaces become available and are filled by those on the waiting list on a first-come, first-served basis.

*Children become disenrolled from CHIP when they reach the age of 19 years, receive other health care coverage (including Medicaid), move from Montana, are over the income guidelines, CHIP is unable to locate the family, or if parents do not renew their children's CHIP insurance.

Page last updated: 8/29/06