How much does it cost to cover my child?

Premiums

The monthly premium for a child is determined by income category. The income category is based on family size, family income, and the health plan you choose. You pay a monthly premium between $4 and $24 for each child, up to a maximum of $72 for all children in a family enrolled in Healthy Families.

Is there an additional cost for my child to get these services?

Yes. In addition to the monthly premiums, you pay a co-payment of $5 to $15 at the time of services for a child's benefits. Some services are free. No individual charge will exceed $15 for a child's benefits.

The maximum co-payment amount per benefit year that you pay for health care services is $250 per family. A benefit year is from October 1 through September 30. Keep all your receipts for the co-payments you make at the time of receiving health care services. Let your health plan know if you reach the maximum $250 for the benefit year of coverage. Then you will not have to make any more $5-$15 co-payment for health care services until the next benefit year of coverage. If you can show that you paid more than $250 in copayments between October 1, and September 30, the plan will reimburse you for the amount over $250.

How do I determine my monthly premium?

To determine the monthly insurance premium for your child, you must first see whether your monthly income falls in Category A, B, or C. You will need the following information:

• Number of family members living in the household.
• Net monthly income (gross income minus deductions allowed).

Deductions allowed

Deduct the following expenses from your gross monthly income:

• If you pay court-ordered child support or alimony, deduct the amount you pay from your gross income.
• If you receive court-ordered child support and/or alimony, you can deduct up to $50 from your family income.
• For each working parent, deduct $90 for work-related expenses. If your income is less than $90 a month, deduct only what you earned.
• For each person receiving Temporary Workman's Compensation or State Disability Insurance, deduct $90. If you receive less than $90 a month, deduct only the amount received.
• Deduct the child daycare expenses you pay for each child or the amount of disabled dependent care paid. The maximum deductible amounts allowed for each child and disabled dependent are:
  • Child under the age of 2 = $200
  • Child 2 years old and over = $175
  • Disabled dependent, any age = $175

To determine net income

1. Figure out your gross monthly income. Add up the gross amounts on your pay stubs. If you are self-employed; call 1-800-880-5305 for help in determining your premium.
2. Add up your total monthly deductions allowed by the program.
3. Subtract your deductions from your gross income. The difference is your monthly net income.