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Benefit Package

• Children with family incomes at or below 133 percent of the FPL in the Medicaid expansion receive the Medicaid benefit package (NJ FamilyCare Plan A).

• Benchmark coverage equal to the FEHBP Blue Cross/Blue Shield plan is provided in the separate child health program (NJ FamilyCare Plans B & C) for children with family incomes above 133 up to and including 200 percent of the FPL.

• Benchmark coverage equal to the plan offered by an HMO that has the largest insured commercial non-Medicaid enrollment in the State is provided in the separate child health program for children with family incomes above 200 up to and including 350 percent of the FPL (NJ FamilyCare Plan D).

• Pregnant women receive Secretary–approved coverage, which is coverage that is the same as the coverage provided to pregnant women under New Jersey’s Medicaid State plan and consists of the full, comprehensive Medicaid benefit package, in addition to pregnancy- related services.

Cost Sharing

• Premiums will be required for children in families with incomes above 200 percent of the FPL (NJ FamilyCare Plan D) as follows: ° $40 per family per month for children with family incomes above 200 up to and including 250 percent of the FPL. ° $79 per family per month for children with family incomes above 250 up to and including 300 percent of the FPL. ° $133 per family per month for children with family incomes above 300 up to and including 350 percent of the FPL.

• Premiums will increase annually with the increases in the FPL.

• Copayments are required for children in families with incomes above 150 percent of the FPL (NJ FamilyCare Plans C & D) as follows: $5 for practitioner visits (including visits to physicians, nurse midwives, nurse practitioners, clinics, podiatrists, dentists, chiropractors, optometrists and psychologists); $5 for outpatient clinic visits; $10 for use of the emergency room under Plan C and $35 under Plan D; $1 for generic prescription drugs and $5 for brand- name prescription drugs in Plan C; and $5 or $10 for both generic and brand-name prescription drugs in Plan D, depending on the amount supplied (up to a 34-day supply or more than a 34-day supply).

• There are no premiums, copayments, or any cost sharing for pregnant women.

Crowd-Out Strategy

• A child with income greater than 133 percent of the FPL must have been uninsured for a minimum of 3 months before becoming eligible for coverage.