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• Hawk-i enrollees receive health and dental benefits through: AmeriChoice, Wellmark Blue Cross Blue Shield, Delta Dental and Wellmark Health Plan of Iowa.
Cost Sharing
• Iowa continues to utilize a 20 percent income disregard in establishing income levels for purposes of determining premium amounts. Hawk-i premiums are $10 per child per month, with a maximum of $20 per family for families whose income is at or above 150 percent up to 200 percent of the FPL; and premiums are $20 per child per month, with a maximum of $40 per family for families whose net income is above 200 percent but up to and including 300 percent of the FPL.
• Families whose countable income is equal to or greater than 150 percent of the FPL shall be assessed a $25 copayment for each emergency room visit if the child’s medical condition does not meet the definition of emergency medical condition.
• At current poverty levels, the family would have to incur the number of inappropriate
emergency room (ER) visits indicated below to exceed 5 percent. Health plans will report enrollee ER usage, resulting in a copayment obligation, to the third party administrator. The third party administrator will track the ER copayment to ensure cost sharing does not exceed 5 percent of the family income. At the point the ER copayment results in cost sharing exceeding 5 percent, enrollees will be reimbursed for the cost. Number of children in family Annual Income at 300% FPL 5% Premium Maximum 5% minus premium maximum
No. of Annual Inappropriate ER Visits 1 $32,490 $1,624.50 $240 $1,384.50 ($1384.50/$25) 55 2 $43,710 $2,185.50 $480 $1,705.50 ($1705.50/$25) 68 3 $54,930 $2,746.50 $480 $2,266.50 ($2266.50/$25) 91 4 $66,150 $3,307.50 $480 $2,827.50 ($2827.50/$25) 113 5 $77,370 $3,868.50 $480 $3,388.50 ($3388.50/$25) 136 6 $88,590 $4,429.50 $480 $3,949.50 ($3949.50/$25) 158 7 $99,810 $4,990.50 $480 $4,510.50 ($4510.50/$25) 180 8 $111,030 $5,551.50 $480 $5,071.50 ($5071.50/$25) 203
• There is no cost sharing for Native American/Alaskan Native children.