All Kids Standards, Premiums and Co-pays

All Kids Level 2

revised text2015 Income Standards

# in

unit

Premium Level 2

MAGI - Over 209% to 318% FPL

(includes 5% disregard)

1 $2,051 - 3,119
2 2,775 - 4,221
3 3,500 - 5,324
4 4,225 - 6,426
5 4,949 - 7,529
6 5,674 - 8,631
7 6,398 - 9,733
8 7,123 - 10,836
9 7,848 - 11,938
10 8,573 - 13,040
Each add'l +1,102

All Kids & FamilyCare Premiums and Physician Co-Pays

Assist

children & adults

Share

children

Premium Level 1

children

Premium Level 2

children

Co-Pay for Physician Office Visit

$0 for children;

$3.90 for adults

$3.90 $5 for children $10 for children
Monthly Premium None None

$15 - 1 person

$25 - 2 persons

$5 each add'l

$40 per child
Max Monthly Premium N/A N/A $40 for 5 or more persons $80 for 2 or more children
Max Co-Payments per Year N/A $100 per family $100 per family $125 per child per calendar quarter