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.

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.