PM 06-08-01-c: Copay Met (All Kids Share and Premium)

WAG 06-08-01-c

revised textAll Kids Share & Premium Level 1

revised textUnder All Kids Share and Premium Level 1, a family's copay maximum is $100 per year.  Once a family pays $100 in copays, they are responsible for sending the receipts to the HFS All Kids Unit in Springfield. The All Kids Unit determines if the copay maximum is met.

In the legacy system, if the copay maximum was met, an indicator was put on the Client Database (CDB). Effective with IES Phase 2 implementation, contact HFS Medical Policy for guidance until a process to systemically track copays is developed. deleted text

When a new 12-month eligibility period is set up, the copay limit must be met again. deleted text

All Kids Premium Level 2

Under All Kids Premium Level 2, children have a maximum copayment for hospital services only. The annual maximum copayment is $500 per child for hospital services. The copay maximum is tracked per child by plan year. The plan year is the same as the state fiscal year (July through June) regardless of when a case is approved.

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