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included in the members Evidence of Coverage booklet which is mailed to each family when a child within the household is enrolled. Any changes to the cost sharing requirements would be presented in public forums and also require review and approval by the State’s Department of Managed Health Care prior to implementation. The public forums vary by county however all of them have confirmed that community input would be solicited. The various types of public forums include Health Plan Board meetings, Health Plan Commission meetings, local Prop 10 Commission meetings, and the Children’s Health Initiative Coalition Oversight Board. 8.4. The state assures that it has made the following findings with respect to the cost sharing in its plan: (Section 2103(e)) 8.4.1. Cost-sharing does not favor children from higher income families over lower income families. (Section 2103(e)(1)(B)) (42CFR 457.530) 8.4.2. No cost-sharing applies to well-baby and well-child care, including age-appropriate immunizations. (Section 2103(e)(2)) (42CFR 457.520) 8.4.3. No additional cost-sharing applies to the costs of emergency medical services delivered outside the network. (Section 2103(e)(1)(A)) (42CFR 457.515(f)) 8.5 Describe how the state will ensure that the annual aggregate cost-sharing for a family does not exceed 5 percent of such family’s income for the length of the child’s eligibility period in the State. Include a description of the procedures that do not primarily rely on a refund given by the state for overpayment by an enrollee: (Section 2103(e)(3)(B)) (42 CFR 457.560(b) and 457.505(e)) HEALTHY FAMILIES INSURANCE PROGRAM Premiums Table 1: HFP Premium Contributions for Families below 150% FPL California will ensure that the annual aggregate cost-sharing for a family with incomes less than 150% FPL is less than that required by Section 1916(b)(1) and Section 1916(2)(3) as is required under Title XXI. The maximum monthly premium charge for Healthy Families insurance program is consistent with the standards established under Section 447.52 of Title 42 of the Code of Federal Regulations (CFR). Healthy Families’ premiums for families below 150% are $7 per child per Effective Date: Approval Date: November 1, 2009 HFP Family Contribution Increase November 1, 2009 HFP Co-Payment Increase November 1, 2009 HFP Limited Dental Plan Choice for New Subscribers

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