The health benefit coverage remains benchmark- equivalent. Cost Sharing There will be no cost-sharing in phase 1. Cost sharing in phase 2 will consist of premiums and co-pays. The family will be educated on the amount of their limit, how to track cost-sharing and how to contact the State once they equal or exceed their limit. The family will be sent a letter from the State advising them that cost-sharing will cease for the remainder of the current 12 month eligibility period.
Providers are responsible for collection of co-pays.
A family's eligibility may be terminated after sixty days due to non-payment of premium except for pregnant teens. In addition, a family who fails to pay the montly premium will be locked out from reapplying for a 3 month period. This will apply to families who do not meet the good cause provisions. An application will be disapproved if it is determined that the child was covered under a health insurance plan within the last six months. However, an application may be approved for good cause.