WAG 06-08-01-b
There are no copays for well-baby care, well-child care, or immunizations. Copays are not required for families whose members are American Indian or Alaska Native under Share or Premium Level 1. Copays are required for American Indian and Alaska Native families under Premium level 2 and 3.
The most a family receiving All Kids/FamilyCare Share or Premium Level 1 has to pay in copays during their 12-month eligibility period is $100.
Families receiving Premium Level 2 have an out of pocket maximum per child for hospital services only. There is no out of pocket maximum for adults in Premium Levels 2 and 3.
It is up to the provider to collect the copay or choose not to charge the copay. Copays do not affect the payment HFS makes to the provider. A provider can refuse to accept a patient who refuses to pay their copay.
All Kids/FamilyCare Share Copays
| Service |
Copay |
| doctor/office visit |
$2 |
| home health care visit |
$2 for children; $0 for adults |
| inpatient hospitalization |
$2 for children; up to $3 per day for adults |
| outpatient visit |
$2 for children; $0 for adults |
| 30-day supply drugs |
$2 for children (generic or brand name);
for adults $0 for generic and $3 for brand name
|
| emergency room visit |
$2 for children; $0 for adults |
| maximum copays per year |
$100 per family |
All Kids/FamilyCare Premium Level 1 Copays
| Service |
Copay |
| doctor/office visit |
$5 for children; $2 for adults |
| home health care visit |
$5 for children; $0 for adults |
| inpatient hospitalization |
$5 for children; up to $3 per day for adults |
| outpatient visit |
$5 for children; $0 for adults |
| 30-day supply drugs |
for children $3 for generic and $5 for brand name;
for adults $0 for generic and $3 for brand name
|
| emergency room visit |
$5, or $25 for nonemergency visit for children;
$0 for adults
|
| maximum copays per year |
$100 per family |
All Kids/FamilyCare Premium Level 2 Copays
| Service |
Copays |
| doctor/office visit |
$10 for children; $2 for adults |
| home health care visit |
no copays |
| inpatient hospitalization |
$100 per admission for children; up to $3 per day for adults |
| outpatient visit |
5% of total cost for children; $0 for adults |
| 30-day supply drugs |
for children $3 for generic and $7 for brand name;
for adults $0 for generic and $3 for brand name
|
| emergency room visit |
$30 for children; $0 for adults |
| maximum copays per year |
$500 per child for hospital services |
FamilyCare Premium Level 3 Copays
| Service |
Copays |
| doctor/office visit |
$2 for adults |
| inpatient hospitalization |
up to $3 per day for adults |
| outpatient visit |
$0 for adults |
| 30-day supply drugs |
for adults $0 for generic and $3 for brand name |
| emergency room visit |
$0 for adults |
| maximum copays per year |
N/A ??? |
