WAG 06-08-01

All Kids/FamilyCare Share and Premium

revised textPersons eligible under All Kids/FamilyCare Share or Premium get a monthly medical card. They get the same services as an Assist case, except abortions and Home and Community-Based waiver services are not covered. Also, non-emergency transportation is not covered under Premium Level 2.

There are copays under the Share and Premium programs. Additionally, a family must pay premiums under the Premium program. Families whose members are American Indian or Alaska Native do not pay copays or premiums if their income is equal to or less than 200% of the FPL.

Families receiving All Kids/FamilyCare Share and Premium Level 1 have a maximum copay of $100 in a year. Copays and premiums are based on the family's size and monthly income. Copays for adults are different than copays for children. Also, premium amounts for adults in Premium Levels 2 and 3 are different than premium amounts for children.

The All Kids/FamilyCare medical card for Share and Premium Level 1 shows the amount of copays that can be charged and whether or not the copay maximum has been met by the family.

The medical card for All Kids Premium Level 2 includes a message telling the provider to verify the copays electronically through REV, AVRS, or MEDI.

All Kids/FamilyCare Rebate

If a person is eligible for All Kids/FamilyCare Rebate, HFS reimburses the policyholder for the cost of the health insurance. The policyholder may or may not be the eligible person. The amount of reimbursement is the lesser of $75 per family member per month, or the amount the policyholder actually pays for the health insurance.

Example 1: Ms. A's son, John is eligible for All Kids/FamilyCare Rebate. Ms. A carries health insurance on her son which costs $100 per month. Ms. A's Rebate payment is $75.

Example 2: Mr. B's daughter, Barbie is eligible for All Kids/FamilyCare Rebate. Mr. B carries health insurance on his daughter which costs $35 per month. Mr. B's Rebate payment is $35.

Example 3: Ms. C's children, Carrie and Chuck are eligible for FamilyCare Rebate. Ms. C has health insurance on herself and her 2 children. It costs her $125 per month. Under her group health insurance plan, the cost for the employee's own coverage is $25. The cost for the first dependent is $60 and $40 for each additional dependent. Ms. C's Rebate payment will be $125.

If the total cost to the policyholder for the eligible members (or persons) is less than $1.00 a month, the family is ineligible for All Kids/FamilyCare Rebate.

Example: Mr. D's daughter, Delaney, is covered by his insurance policy. Mr. D's employer provides the dependent coverage at no cost to the employee. Delaney is not eligible for All Kids/FamilyCare Rebate because insurance is provided at a monthly cost of less than $1.00. She can choose All Kids/FamilyCare Share or All Kids/FamilyCare Premium even if she has health insurance that covers inpatient hospitalization and physician services.  The third party liability (TPL) code must be entered in Form 552 Item 79.

The Department will reimburse the policyholder of the eligible children, whether or not the policyholder lives in the home. Nonfinancial and financial eligibility are still determined based on the family with whom the child lives.

Example: Elaine lives with her mother. Her father pays for her health insurance. In order to receive All Kids/FamilyCare Rebate, Elaine's mother must apply for her and eligibility will be based on her mother's income. The Rebate payment will be paid to Elaine's father.

For families receiving All Kids/FamilyCare Rebate, the copays and premiums that the family must pay are based on the individual health insurance policy.

Persons eligible for Rebate do not receive an All Kids/FamilyCare medical card since the Department does not pay medical bills for the person.