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PA Children's Health Insurance Program

        PA CHILDREN'S HEALTH INSURANCE FORM             

Unexpected Accidents Can Happen. Help protect your child at school and at play with the below insurance options:

If you would like to enroll your child in this program, please download and complete the application and return it with the required premium in the form of a check or money order to:

                                                                       A-G Administrators LLC
                                                                       PO Box 824936
                                                                       Lock Box#824936
                                                                       Philadelphia, PA 19182-4936

First page of the PDF file: CHIP-Strong-flyer_En_1
First page of the PDF file: CHIP-Strong-flyer_Sp_1