CHIPChildren ages 0 through 18 |
|
|---|---|
| Monthly cost | $0 for Free CHIP $25.00, $40.00, or $50.00 per month per child for Low-Cost CHIP $236.53 per month per child for Full-Cost CHIP |
| Type of coverage | Keystone Health Plan East HMO |
| Eligibility based on | Family size and income |
| Wait period (if eligible) | None |
| Pre-existing condition rule | No |
| Copays | $0 for Free CHIP $5 PCP*/$10 specialist for Low-Cost CHIP $15 PCP/$25 specialist for Full-Cost CHIP |
| Benefits | |
| Doctor office visits | $0 for Free CHIP $5 PCP*/$10 specialist for Low-Cost CHIP $15 PCP/$25 specialist for Full-Cost CHIP |
| Hospitalization | limited to 90 days per year |
| Surgery and anesthesia | covered |
| Emergency care | $0 for Free CHIP, $25 for Low-Cost CHIP, and $50 for Full-Cost CHIP (waived if admitted) |
| Diagnostic services | covered |
| Chemotherapy and radiation | covered |
| Maternity care | covered |
| Newborn care | covered for up to 31 days following birth |
| Dental | covered; no orthodontia |
| Vision and hearing | covered; includes eyeglasses and hearing aids |
| Prescription drugs | $0 for Free CHIP $6 generic/$9 brand name for Low-Cost CHIP $10 generic/$18 brand name for Full-Cost CHIP |
| Durable medical equipment (DME) | covered |
| Mental health | covered |
| Serious mental illness | covered |
| Substance abuse | covered |
1 Except for well-child visits
2 Orthodontic Services: Covered only if your child is diagnosed with a significant handicapping malocclusion or other severe condition. (Prior authorization is mandatory and must be provided by a participating orthodontist.)
