Healthy Kids - How Much does it Cost?

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Healthy Kids

How Much Does It Cost?

The family's Healthy Kids premium will be $4 to $6 per per child per month, with a maximum of $18 per family, depending upon income. (See chart below.) Families may pre-pay 3 months of their share of the premium and receive the fourth month free, or, pay for 9 months and receive the fourth quarter free.

In addition to the monthly family contribution to premium, there are co-payments for certain services (the same as Healthy Families):

CATEGORY	TYPES OF SERVICES	COPAYMENT
Hospital stays, clinic visits	All in-patient, acute and Skilled Nursing Facility stays (100 days)	None
Hospital stays, clinic visits	All Outpatient Services	$5
Professional Services	Inpatient-based	None
	Office or home visit	$5
	Visits for chemotherapy, dialysis, surgery, anesthesiology, radiation	$5
Well-Baby Care	Newborn hospital visits, office health exams, ages 0-2	None
Preventive Services	Visits for immunizations, periodic health exams, well-child visits, STD tests, cytology exams, family planning, vision and hearing tests, prenatal care, health education	None
Diagnostic x-ray and Laboratory Services	Therapeutic radiology services, ECG, EEG, mammography, other outpatient diagnostic laboratory and radiology tests	None
Prescriptions	Generic or name brand drugs	$5
Prescriptions	Inpatient drugs and drug administration in a physician's office, as well as FDA-approved contraception drugs and devices	None
Mental Health	Inpatient limited to 30 days/year	None
Mental Health	Outpatient visits up to 20 visits per year	$5
Drug and Alcohol	Inpatient detoxification	None
Drug and Alcohol	Crisis intervention and substance abuse prevention	$5
Other Services	Orthotics, prostheses, medical transportation	None
Other Services	Physical, occupational, and speech therapy	$5

Want to know more
about Healthy Kids?
Go to:

View our Healthy Kids
Member Handbook

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For more information:

Department of
Managed Health Care

California Department
of Insurance

Experience shows that some families have a difficult time paying monthly premiums for insurance coverage however small it may be. For those families for whom the monthly share of premium is a barrier to enrolling their children into Healthy Kids, a separately operated Premium Assistance Fund has been established. Families may request this assistance through the Santa Clara Family Health Plan, which will evaluate the application based on family size, income, and extraordinary circumstances.

Families may request this assistance from us at 1-800-260-2055. We will evaluate the application based on family size, income, and extraordinary circumstances. Families qualifying for the Premium Assistance will not be billed their monthly share of premium for the remainder of their enrollment year. The Premium Assistance Fund will cover only the family's monthly share of premium payment.

Rather than disenrolling children automatically after two months of non-payment of the Family Contribution (current Healthy Families practice), Healthy Kids will "bill" the Premium Assistance Fund and try to contact the family to determine the reasons for non-payment. Should the family subsequently qualify for the Premium Assistance Fund, the payments will be made for the family. In those instances where non-payment is a choice, not the need for assistance, the children will be disenrolled from Healthy Kids.

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