Out-of-Pocket Costs

 

  All Kids Share
133-150% Children
All Kids Premium
Level 1
150-200%
Children
All Kids Premium
Level 2
200-300% Children
Monthly Premium
None $15 for 1
$25 for 2
$30 for 3
$35 for 4
$40 for 5 or more children
$40 per child
Max Monthly Premium
N/A $40 for 5 or more persons
$80 for 2 or
more children
Each Visit to a Doctor
$3.90 $5
$10
Each Name Brand or Generic Prescription
$3.90 or $2 $5 or $3
$7 or $3
Each Emergency Room Visit
N/A $5 for emergency or $25 for non-emergency
$30 for emergency or non-emergency
Each Hospital Admission
$3.90 per admission $5 per admission
$100 per admission
Percentage of HFS rate for each Outpatient Service
N/A N/A
5%
Max per Child per Year Co-Payments for Hospital Services
$100 per family $100 per family
$500 per child
 
All Kids Hotline 1-866-ALL-KIDS (1-866-255-5437)
TTY: 1-877-204-1012



All Kids

 

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