Section 123.320  Co-payments and Cost Sharing

a)         Co-payments or cost sharing may be charged for services provided to a child by a health care provider as described in subsection (b), except for practitioner visits scheduled for well-baby care, well-child care, age appropriate immunizations, preventative dental visits or family planning services.

b)         Co-payment and cost sharing requirements are as follows:

1)         Practitioner office visit:

A)        All Kids Premium Level 2 co-payment:  $10 per visit.

B)        All Kids Premium Level 3 co-payment:  $15 per visit.

C)        All Kids Premium Level 4 co-payment:  $20 per visit.

D)        All Kids Premium Levels 5-8 co-payment:  $25 per visit.

2)         Dental visits:

A)        All Kids Premium Level 2 co-payment:  $10 per visit.

B)        All Kids Premium Level 3 co-payment:  $15 per visit.

C)        All Kids Premium Level 4 co-payment:  $20 per visit.

D)        All Kids Premium Levels 5-8 co-payment:  $25 per visit.

3)         Inpatient hospitalization:

A)        All Kids Premium Level 2 cost sharing:  $100 per admission.

B)        All Kids Premium Level 3 cost sharing:  $150 per admission.

C)        All Kids Premium Level 4 cost sharing:  $200 per admission.

D)        All Kids Premium Levels 5-7 cost sharing:  10 percent of Department's rate.

E)         All Kids Premium Level 8 cost sharing:  25 percent of Department's rate.

4)         Hospital or Ambulatory Surgical Treatment Center outpatient encounter with a payable service on the Ambulatory Procedure List as set forth in 89 Ill. Adm. Code 148.140:

A)        All Kids Premium Level 2 cost sharing:  5 percent of the Department's rate.

B)        All Kids Premium Level 3 cost sharing:  10 percent of the Department's rate.

C)        All Kids Premium Level 4 cost sharing:  15 percent of the Department's rate.

D)        All Kids Premium Levels 5-7 cost sharing:  20 percent of the Department's rate.

E)         All Kids Premium Level 8 cost sharing:  25 percent of the Department's rate.

5)         Hospital Emergency Visit:

A)        All Kids Premium Level 2 co-payment:  $30 per visit.

B)        All Kids Premium Level 3 co-payment:  $50 per visit.

C)        All Kids Premium Level 4 co-payment:  $75 per visit.

D)        All Kids Premium Levels 5-8 co-payment:  $100 per visit.

6)         Prescription drugs:

A)        All Kids Premium Level 2 co-payment:  $3 for a 1 to 30-day supply of generic drugs or $7 for a 1 to 30 day supply of brand name drugs.

B)        All Kids Premium Level 3 co-payment:  $6 for a 1 to 30-day supply of generic drugs or $14 for a 1 to 30 day supply of brand name drugs.

C)        All Kids Premium Level 4 co-payment:  $9 for a 1 to 30-day supply of generic drugs or $21 for a 1 to 30 day supply of brand name drugs.

D)        All Kids Premium Levels 5-8 co-payment:  $12 for a 1 to 30-day supply of generic drugs or $28 for a 1 to 30 day supply of brand name drugs.

c)         The out-of-pocket cost sharing expense a child shall incur for services under subsections (b)(3), (4) and (5) of this Section during the plan year July 1 to June 30 shall be limited as follows:

1)         All Kids Premium Level 2 – $500 per child.

2)         All Kids Premium Level 3 – $750 per child.

3)         All Kids Premium Level 4 – $1,000 per child.

4)         All Kids Premium Levels 5-7 – $5,000 per child.

5)         All Kids Premium Level 8 – no maximum.

d)         Providers will be responsible for collecting co-payments under the All Kids Health Insurance Plan.

e)         Providers may elect not to charge co-payments.  If co-payments are charged, the co-payment may not exceed the amounts established in subsection (b).

f)          The Department will not require providers to deliver services when co-payments properly charged under the All Kids Premium Health Plans are not paid.