All Kids Standards, Premiums and Co-pays

All Kids Level 2

revised text2014 Income Standards

# in

unit

Premium Level 2

MAGI - Over 209% to 318% FPL

(includes 5% disregard)

1 $2,034 - 3,093
2 2,741 - 4,168
3 3,448 - 5,244
4 4,155 - 6,320
5 4,862 - 7,396
6 5,569 - 8,472
7 6,276 - 9,548
8 6,983 - 10,624
9 7,690 - 11,700
10 8,397 - 12,776
Each add'l +1,076

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;

revised text$3.90 for adults

revised text$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