Member Handbook for Parkland KIDSfirst and Parkland CHIP ...

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• Custodial care (care that assists a child with the activities of daily living, such as assistance in walking, getting in and out of bed, bathing, dressing, feeding, toileting, special diet preparation, and medication supervision that is usually self-administered or provided by a parent. This care does not require the continuing attention of trained medical or paramedical personnel.) This exclusion does not apply to hospice. • Housekeeping • Public facility services and care for conditions that federal, state, or local law requires be provided in a public facility or care provided while in the custody of legal authorities • Services or supplies received from a nurse, which do not require the skill and training of a nurse • Vision training and vision therapy • Reimbursement for school-based physical therapy, occupational therapy, or speech therapy services are not covered except when ordered by a Physician/PCP • Donor non-medical expenses • Charges incurred as a donor of an organ when the recipient is not covered under this health plan What Are Co-Payments? How Much Are They and How Do They Apply? Parkland KIDSfirst Members The following table lists the CHIP co-payment schedule according to family income. Copayments for medical services or prescription drugs are paid to the health care provider at the time of service. No co-payments are paid for preventive care such as well-child or well-baby visits or immunizations. Your child’s Parkland KIDSfirst ID card lists the co-payments that apply to your family situation. Present your child’s ID card when you receive office visit or emergency room services or have a prescription filled. Federal Poverty Levels Native Americans Office Visits Emergency Room Visits $0 $0 Inpatient Hospitalizations $0 Prescription Generic Drugs Prescription Brand Drugs $0 $0 $0 Annual Reporting Caps At or Below 100% $3 $3 $10 $0 $3 $1.25% of family’s net income 101%- 150% 151%- 185% 186%- 200% $5 $5 $25 $0 $5 $7 $50 $50 $5 $20 $10 $50 $100 $5 $20 1.25% of family’s net income 2.5% of family’s net income 2.5% of family’s net income PKF-M100708R 23
Parkland CHIP Perinate Newborn Members There are no co-pays for services covered by the CHIP Perinatal Program. What about Other Services or Programs? There are other services that are not a part of Parkland KIDSfirst and Parkland CHIP Perinate Newborn. Your child may also qualify for some of the following services or programs: • The Children’s Education Fund (CEF). CEF can provide families with help in paying tuition for children who are in kindergarten through eighth grade. Families may qualify for tuition scholarships up to $1000 for Dallas County residents. • ECI (Early Childhood Intervention) Program. ECI can provide services in your home or in the community for children, birth to three years old who are developmentally delayed. Some of the services for children include: screenings, physical, occupational, speech and language therapy, and activities to help children learn better. • Women, Infants, and Children (WIC) program. WIC can help infants and children under 5 years old, and pregnant and breastfeeding women who qualify to get nutritious food, nutrition education, and counseling. You do not have to go to your child’s PCP to get these services. If you have questions or need help, call Member Services toll-free at 1-888-814-2352. What Extra Benefits Does a Member of Parkland KIDSfirst or Parkland CHIP Perinate Newborn Get? When your child joins Parkland KIDSfirst or Parkland CHIP Perinate Newborn, he or she will get extra benefits. Your child can get: • Free Membership to Boys and Girls Club of Greater Dallas – A program for young people between the ages of 6 and 18, who will be able to become a part of various health education programs and other activities. When your child joins these activities, he or she will help to develop the qualities needed to become responsible citizens and leaders. These programs include: Sports Activities, Fitness Activities, Recreation Activities, Character and Leadership Development, Education and Career Development, Health and Life Skills, and Educational Programs for The Arts. PKF-M100708R 24
Page 1 and 2: This book belongs to:______________
Page 3 and 4: WELCOME TO OUR PARKLAND KIDSfirst a
Page 5 and 6: ‣ We may provide information to a
Page 7 and 8: If you believe your privacy rights
Page 9 and 10: • What if I/my child has an emerg
Page 11 and 12: The Member ID is the same as your c
Page 13 and 14: How Do I Choose My Child's Primary
Page 15 and 16: You will get a letter in the mail i
Page 17 and 18: Parkland CHIP Perinate Newborn Memb
Page 19 and 20: • serious impairment to bodily fu
Page 21 and 22: Type of Benefit Description of Bene
Page 31: What benefits are not covered? Serv
Page 35 and 36: care is known as routine medical ca
Page 37 and 38: (How Do I Get Medical Care after My
Page 39 and 40: eferral is needed. Only one pair of
Page 41 and 42: You/ your daughter may contact any
Page 43 and 44: Parkland CHIP Perinate Newborn Memb
Page 45 and 46: 5. Learn about what your health pla
Page 47 and 48: How will I be notified if services
Page 49 and 50: The Member Advocate will listen to

Member Handbook for Parkland KIDSfirst and Parkland CHIP ...

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