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 co-payment: $10 per visit.

2)         Dental visits co-payment: $10 per visit.

3)         Inpatient hospitalization cost sharing: $100 per admission.

4)         Hospital or Ambulatory Surgical Treatment Center outpatient encounter, as set forth in 89 Ill. Adm. Code 148.140, cost sharing: 5% of the Department's rate.

5)         Hospital Emergency Visit co-payment: $30 per visit.

6)         Prescription drugs 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.

c)         The out-of-pocket co-payment and cost sharing expense children enrolled in All Kids Premium Level 2 will incur shall not exceed $250 per annual enrollment period multiplied by the number of children in the family enrolled in All Kids Premium Level 2. 

d)         Providers will be responsible for collecting co-payments.

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 Program are not paid.

(Source:  Amended at 44 Ill. Reg. 19697, effective December 11, 2020)