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6.1.4.1

Coverage the same as Medicaid State plan

The coverage for children with family incomes no greater than 200% FPL is the same as our Medicaid benefit plan.

6.1.4.2

Comprehensive coverage for children under a Medicaid Section 1115 demonstration project

6.1.4.3 Coverage that either includes the full EPSDT benefit or that the state has extended to the entire Medicaid population

6.1.4.4 Coverage that includes benchmark coverage plus additional coverage

6.1.4.5 Coverage that is the same as defined by existing comprehensive state- based coverage

6.1.4.6 Coverage under a group health plan that is substantially equivalent to or greater than benchmark coverage through a benefit by benefit comparison (Please provide a sample of how the comparison will be done) The Benchmark-Equivalent Plan which is provided to children with family incomes greater than 200% FPL is substantially equivalent to the most widely available and most widely purchased commercial plan in Wisconsin, the United Health Care Plan. We have reviewed the United Health Care Plan benefits and modified them slightly in regard to the copayments and service limits. This modified plan has been adopted as the Benchmark Plan for both children eligible for SCHIP with incomes greater than 200% FPL, but also for pregnant women, eligible under Medicaid, with incomes that exceed 200% FPL.

The benchmark-equivalent plan we’re providing has slightly better benefits and cost sharing then the parent plan, United Health Care Group Health Plan, since we lowered the cost sharing and then added a more comprehensive mental health/substance benefit from the State Employee’s Group Plan.

WISCONSIN

Effective Date:

Approval Date: 27