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74 POPULATION 2 (UNBORN) Co-payments and premiums are not applicable to this population.

POPULATION 3 (MCAP)

Premiums The premium charged to pregnant women (unborn) enrolled on or after July 1, 2004, is limited to 1.5 percent of family income. Copayments and deductibles are not applicable to this population.

California ensures that the annual aggregate cost-sharing for a family does not exceed 5 percent of a family’s income as is required by Section 2103(3)(B) of title XXI. The table below demonstrates that the maximum cost sharing falls well within the 5 percent annual cap.

Table 2: Aggregate Premiums for Pregnant Women/Families Above 208 percent of FPL up to and including 317 percent of FPL: Family Size Annual Income of a Single Parent Family @ 208% FPL + $1* 5% Ceiling Percentage of Annual Income Annual Premium Contribution

1 child $33,781 $1,689 1.5% $507 2 children $42,475 $2,124 1.5% $637 3+children $51,169 $2,558 1.5% $767

*Dollar amounts are based on March 1, 2017 FPL.

POPULATION 4 (MCAIP)

Premiums California ensures that the annual aggregate cost-sharing for a family does not exceed 5 percent of a family’s income as is required by Section 2103(3)(B) of title XXI. Copayments and deductibles are not applicable to this population. The table below demonstrates that the maximum cost sharing falls well within the 5 percent annual cap.

Table 3: Aggregate Cost Sharing for Families Above 261 percent FPL up to and including 317 percent FPL for MCAIP