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Premiums and Copays

Outlined below are the premiums and copayments for children in the ALL Kids Low Fee and Fee groups. These amounts are effective June 1, 2012. Those in the No Fee group will not be charged copayments or premiums.

Annual Premiums

 

Low Fee Group

Fee Group

 

$52.00 (Not to exceed $156 per family)

$104.00 (Not to exceed $312 per family)

Copayment

 

Low Fee Group

Fee Group

Service

 

 

Inpatient Admission

$200.00

$200.00

Ambulance

$6.00

$100.00

Outpatient Surgery

$6.00

$100.00

Emergency Room Services

$6.00

$60.00

Non-Emergency ER Services

$6.00

$60.00

Outpatient Diagnostics (X-Rays)

$6.00

$65.00

Doctor visit for non-preventive service

$3.00

$13.00

Allergy Testing

$6.00

$17.00

Allergy Treatment

$3.00

$12.00

Dental visit for non-preventive service

$5.00

$20.00

Behavioral Health Office Visits

$3.00

$13.00

Behavioral Health Inpatient Admission

$200.00

$200.00

Substance Abuse Inpatient Admission

$200.00

$200.00

Generic Drug

$1.00

$5.00

Preferred Drug

$5.00

$25.00

Non-Preferred Drug

Not covered

Not covered

Annual Out-Of-Pocket Maximum

Effective June 1, 2012, no family will be required to pay more than 5% of their annual income (the income used to determine eligibility for ALL Kids) in out-of-pocket expenses (premiums and copayments) annually. It is the family’s responsibility to contact ALL Kids when you are close to reaching your out-of-pocket maximum. The family will be asked to send in receipts for these expenses.

If you have any questions, or would like to know your family's exact annual out-of pocket maximum please call our toll-free number 1-888-373-KIDS (5437) between 8:00 a.m. and 5:00 p.m, Monday through Friday to talk with an ALL Kids Customer Service representative. You may also email us from our website (www.adph.org).


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