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CHIP Affordability Test Calculator Instructions

1. Pull up the CHIP Affordability Test Calculator

2. Select the appropriate tab on the left-hand side for CHIP

Affordability Calculator for CHIP x

CHIP-

Please Enter DCN for the Participant PC Select County of Residence for the Participant ————————————es|

Select Individual or Couples ° Individual - Couples | + Select Nienber‘of Ghikiven Select Income Range for Household

pea © (CHPTS) 150% — 155% of FPL..affordabiity standard = $36

© Two Children © (CHIP74) 186% - 225% of FPL...affordabilty standard = $142

Bi rN tal Sha (CHIP7S) 225% - 300% of FPL. .affordabilty standard = $216

j Select Age of the Adult(s) in the Household

’ 0 to 49 ws © 21 to 29 years to 49 years © 30 to 39 years 50 years or greater

Test CHIP affordabaty _|

3. Select “County” in the drop-down box

4. Select the Test type: Individual or Couples. For a one parent household, select Individual. For a two parent household, select Couples.

5. Select the appropriate number of children for CHIP cases

6. Click the appropriate CHIP premium limit

7. Click the appropriate age rage for the head of household

8. Click button labeled Test CHIP Affordability