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Wisconsin ensures that children covered through premium assistance receive benefits that are equivalent to the United Health Care Group Health Plan, with mental health and substance abuse treatment benefits from our state employee’s plan. When a child is enrolled in an employer’s group health plan, the benefits of the Standard or Benchmark Plan, whichever they are qualify for, are wrapped around that health plan to ensure a benefit that is at least equivalent to the benefit they would have received had they not been bought into the employer’s plan.

6.1.4.7 Other (Describe)

6.2 The state elects to provide the following forms of coverage to children: (Check all that apply. If an item is checked, describe the coverage with respect to the amount, duration and scope of services covered, as well as any exclusions or limitations) (Section 2110(a)) (42 CFR 457.490)

For the unborn child, the State covers pregnancy related services and services that if not treated could complicate the pregnancy. The list of services provided for our separate SCHIP unborn population is listed in the attached addendum.

The services checked below are for our separate SCHIP population of children from birth to 19 years up to and including 300% FPL. Children with family income at or below 200% FPL receive the Medicaid or Standard Plan benefit package, while children with family income greater than 200% FPL but no greater than 300% FPL receive a Benchmark-Equivalent Plan benefit package. Details about the amount, duration and scope of the covered services are provided in Attachment 3.

6.2.1

Inpatient services (Section 2110(a)(1))

6.2.2

Outpatient services (Section 2110(a)(2))

6.2.3

Physician services (Section 2110(a)(3))

6.2.4

Surgical services (Section 2110(a)(4)) See Physician Services in Attachment 3

6.2.5

Clinic services (including health center services) and other ambulatory health care services (Section 2110(a)(5)) See Physician Services in Attachment 3

6.2.6

Prescription drugs (Section 2110(a)(6))

WISCONSIN

Effective Date:

Approval Date: 28