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Benefit Package

• Initially, the State used the benefit package of the HMO with the State’s largest non- Medicaid enrollment as the benchmark for ALL Kids, but the State has made several benefit additions and enhancements to the package. Children enrolled in ALL Kids Plus receive additional services that are developmentally or physically necessary.

Cost Sharing

• There are three (3) categories of enrollees: No Fee (Native Americans and Alaskan Natives).; Low-Fee (children with family incomes from the base through 150% FPL); and Fee (children with family incomes from 151% FPL through 300% FPL). There is no cost sharing for children in the No Fee group. There is a $50 premium per child, per year for children in the Low-Fee group. There is a $100 premium per child, per year for children in the Fee group. Premiums can be paid in one payment or in periodic payments (weekly, monthly, or quarterly) throughout the year. A family’s total premium payments cannot exceed three times the individual premium rate (i.e. $150 or $300 depending upon the income level of the family). Enrollment data systems do not allow for a family to be billed in excess of these amounts.

• ALL Kids enrollees are required to pay copayments for nonpreventive services. Copayment amounts depend on family income.

Service Family Income < or = 150% of FPL Family Income > 150% of FPL Dental $3 per visit $5 per visit Doctor office $3 per visit $5 per visit ER services $5 facility charge $15 facility charge Inpatient services $5 per confinement $10 per confinement Non-emergency ER $10 per visit $20 per visit Allergy testing $5 per lab visit $10 per lab visit Allergy treatment $3 per visit $5 per visit Ambulance $5 per occurrence $10 per occurrence Mental and nervous inpatient $5 per confinement $10 per confinement Outpatient surgical facility $5 per visit $10 per visit Substance abuse inpatient $5 per confinement $10 per confinement X-ray $3 per visit $5 per visit Generic prescriptions $1 $2 Preferred prescriptions $3 $5 Non-preferred prescriptions $5 $10