Hospital Care - Semiprivate room, medications, laboratory texts, x-rays,
surgeries, and professional care.
Outpatient care - includes diagnostic services, therapies, laboratory services,
X-rays, and outpatient services.
Physician and clinic services - office visits; preventive services such as one well visit per year between 6 and 7, and once every three years between 7 and 19.
Immunizations are covered.
Surgical services - includes standard surgical procedures, related services,
surgeon's fees, and anesthesia.
Prescription drugs
Laboratory and radiology services
Inpatient mental health services - requires precertification
Outpatient mental health services - requires precertification after 26
outpatient visits per year.
Durable medical equipment and supplies such as wheelchairs
Vision
Hearing
Home health care - limited to patients who are homebound and need care that
can only be provided by licensed health care professionals or in the case that a physician
certifies that the patient would other wise be confined to a hospital or skilled nursing
facility. Professional health care is covered; care provided by an unlicensed caregiver is
not.
Nursing care
Dental care includes oral examinations, teeth cleaning, and scaling twice during
a 12-month period, full mouth X-rays once every 60 months, bitewing X-rays of the back
teeth once during a 12 month period and routine fillings.
Inpatient substance abuse treatment and outpatient substance abuse treatment -is
covered. See the mental health inpatient and outpatient notes above.
Physical therapy, occupational therapy and therapy for individuals with speech,
hearing and language disorders
Hospice care
Special needs children with chronic mental or physical conditions or illness may
receive services beyond those listed above if services are medically necessary and receive
precertification.
Once a child has been covered under this plan, should family economic conditions change so
that the child is no longer eligible, but the family wants the child to continue in the
program, the family will be allowed to purchase the plan at full premium for one year.
Applying for Health Choice insurance for your children:
A two page application form, income verification and enrollment fee (if required) are
needed to approve the application. This application form will be made available at Social
Services and Health Department. The application can be mailed in or taken to your county
social services department. To expedite the process, come to Department of Social Services
for a face to face interview. Each application will first be looked at to see if the child
is eligible for Medicaid and, if not, then looked at to see if the child is eligible for
the new program. If the child is found to be eligible, the application will be processed
and the parents will receive a health card, a benefits booklet and instructions in the
mail. Once parents are notified, the child is eligible to receive care.
Note: Unlike Medicaid, this program is limited by the amount of funds which are available.
Therefore, it is open only to children on a first come, first served basis. Once the
program is full, a waiting list will be taken, so it is in the best interest of the child
to enroll as soon as it is possible. The state does feel that there are enough funds to
cover all available children, however, there is no exact count of the numbers of uninsured
children in the state. Every effort will be made to notify families through various media
that this program exists and who is eligible.
The state discourages families from dropping current health coverage in order to enroll in
the new child health insurance plan. Therefore, during the first six months of the program
(through April 1999), children can be enrolled who have not had health insurance for six
months. After April 1999, children can be enrolled who have not had health insurance for
two months.