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Services Available to Your Baby through the Healthy Families Program

The Healthy Families Program covers all medically necessary health, dental and vision services for children and teens. While enrolled in Healthy Families, your child's coverage includes:

Healthy Families Services for Children
NOTE: Benefits are provided if the insurance plan determines them to be medically necessary.
Healthy Families Benefits* Services for Children Costs to Member (co-payment)
Category A
Costs to Member (co-payment)
Category B & C
Physician Services
  • Office, home visits
  • Allergy testing and treatment
  • Inpatient/Outpatient care
  • $5 per visit
  • $5 per visit
  • No charge under 24 months of age
  • $10 per visit
  • $10 per visit
  • No charge under 24 months of age
Preventive Care
  • Periodic health examinations (including well-baby care)
  • Variety of voluntary family planning services
  • Prenatal care
  • Vision and hearing testing
  • Immunizations
  • Sexually transmitted disease (STD) testing
  • Confidential HIV/AIDS counseling and testing
  • Annual Pap smear exams
  • Health education services
  • No charge (including office visits)
  • No charge (including office visits)
Prescription Drugs
  • 30 day supply of brand name or generic drugs, including prescriptions for one cycle of tobacco cessation drugs
  • 90 day supply of maintenance drugs purchased through a participating pharmacy or through the plan’s mail order for generic or brand name drugs.
  • While in the hospital
  • FDA-approved contraceptive drugs and devices
  • $5 per prescription

  • $5 per prescription

  • No charge
  • No charge
  • $10 per prescription for generic drugs
  • $15 per prescription for up to 30 day supply for brand name drugs or $10 if there is no generic equivalent or if the use of a brand name drug is medically necessary
  • $10 per prescription for generic drugs
  • $15 per prescription for brand name drugs or $10 if there is no generic equivalent or if brand name drug is medically necessary
  • No charge
  • No charge
Inpatient and Outpatient Hospital Services
  • Inpatient: room and board nursing care and all medically necessary services
  • Outpatient: diagnostic, therapeutic, and surgical services performed at a hospital or outpatient facility
  • No charge
  • No charge "except"
    • $5 per for physical, occupational and speech therapy performed on an outpatient basis
    • • $5 per visit unless hospitalized
  • No charge
  • No charge "except"
    • $10 per for physical, occupational and speech therapy performed on an outpatient basis
    • • $15 per visit unless hospitalized
Emergency Health Care Services
  • 24-hour emergency for illness, injury, or severe pain requiring immediate diagnosis and treatment to avoid placing the subscriber in danger of loss of life, serious illness, or disability
  • Provided both in and out of the health plan's service area and participating facilities
  • $5 per visit unless hospitalized
  • No coverage will be provided if the services received are not an emergency
  • $15 per visit unless hospitalized
  • No coverage will be provided if the services received are not an emergency
Maternity
  • Prenatal and postnatal care, inpatient and newborn nursery care
  • No charge
  • No charge
Family Planning
Services
  • Voluntary family planning services
  • Counseling and surgical procedures for sterilization, as permitted by state and federal law
  • Coverage for diaphragms and other federal Food and Drug Administration approved devices pursuant to the prescription drug benefit
  • Voluntary Termination of Pregnancy
  • No charge
  • No charge
Medical Transportation
  • Emergency ambulance transportation to the hospital, and medically necessary non-emergency transportation to transfer a member from a hospital to another hospital or facility, or facility to home.
  • No charge
  • No charge
Diagnostic X-ray and Laboratory Services
  • Inpatient and outpatient laboratory services, and diagnostic and therapeutic radiological services necessary to appropriately evaluate, diagnose, and treat members
  • No charge
  • No charge
Durable Medical Equipment
  • Medical equipment appropriate for use in the home, oxygen and oxygen equipment, insulin pumps and all related necessary supplies
  • No charge
  • No charge
Inpatient and Outpatient Mental Health Care Services

Mental Health Care

  • Diagnosis and treatment of a mental health condition
  • Inpatient and outpatient services
  • This includes, but is not limited to, the treatment of a member who has experienced family dysfunction or trauma, including child abuse and neglect, domestic violence, substance abuse in the family, or divorce and bereavement
  • Family members may be involved in the treatment when medically necessary for the health and recovery of the member
  • Inpatient and outpatient mental health care visits for the treatment of severe mental illnesses(SMI) means: Schizophrenia, schizoaffective disorder, bi-polar disorder (maniacdepressive
    illness), major depressive disorders, panic disorder, obsessivecompulsive disorder, pervasive developmental disorder of autism, anorexia nervosa, bulimia nervosa.
  • No charge for inpatient services

  • $5 per visit for outpatient services
  • No charge for inpatient services

  • $10 per visit for outpatient services
Serious Emotional Disturbance (SED)
  • Inpatient and outpatient services for the treatment of a member determined by the county to have a SED condition.
  • The Plan and the county mental health department will coordinate services to ensure that all medically necessary services and treatment are provided to a member with SED.
  • The member will remain enrolled in the Healthy Families Program and will continue to receive primary care, specialty care, and all other services for medical conditions not related to the SED from the Plan.
  • No charge for SED
    treatment
  • No charge for SED
    treatment
Inpatient and Outpatient Alcohol and Drug Abuse Treatment
  • Inpatient: As medically appropriate to remove toxic substances from the system
  • Outpatient: Crisis intervention and treatment of alcoholism or drug abuse
  • No charge for inpatient services
  • $5 per visit for outpatient services
  • No charge for inpatient services
  • $10 per visit for outpatient services
Physical, Occupational, Speech Therapy
  • Therapy may be provided in a medical office or other appropriate outpatient setting, hospital, skilled nursing facility, or home. Plans may require periodic evaluations as long as therapy, which is medically necessary, is provided.
  • No charge for inpatient services
  • $5 per visit for outpatient services
  • No charge for inpatient services
  • $10 per visit for outpatient services
Home Health Care Services
  • Services provided at the home by health care personnel
  • No charge except $5 per for physical, occupational, and speech therapy
  • No charge except $10 per for physical, occupational, and speech therapy
Skilled Nursing Care
  • Services provided in a licensed, skilled nursing facility, 100 days each benefit year
  • No charge
  • No charge

Note: The Benefits charts on this Web site are only a summary of benefits provided by each health plan in the AIM and Healthy Families programs. These summaries are for information only. This is not a contract. For exact terms and conditions of the health care benefits, provisions, exclusions, and limitations for each plan, refer to the Evidence of Coverage booklet or Certificate of Insurance available from each health plan. Call the phone number listed on each health plan's description page in Plans and Providers.

See optional, dental and visions services in Healthy Families