PM 06-08-01-b: Copays (All Kids Share and Premium)

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.

The most a family receiving All Kidsdeleted text 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. 

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 Share Copays

Service Copay
doctor/office visit $3.90
home health care visit $3.90
inpatient hospitalization $2
outpatient visit $3.90
30-day supply drugs  $2 for generic or over-the-counter prescription; $3.90 for brand name
emergency room visit $0
maximum copays per year $100 per family

All Kids Premium Level 1 Copays

Service Copay
doctor/office visit $5
home health care visit $5
inpatient hospitalization $5 per day
outpatient visit $5
30-day supply drugs for children $3 for generic and $5 for brand name
emergency room visit $0
maximum copays per year $100 per family

All Kids Premium Level 2 Copays

Service Copays
doctor/office visit $10
home health care visit no copays 
inpatient hospitalization $100 per admission
outpatient visit 5% of total cost
30-day supply drugs for children $3 for generic and $7 for brand name
emergency room visit $30
maximum copays per year $500 per child for hospital services