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Child Plans

Child Only Plans from

Kaiser Permanente

 

Are you looking for affordable health care for your uninsured child? Kaiser Permanente Child Health Plan is a quality health care option that may meet your needs.  You can give your children the health care they need for just $8 or $15 per child, per month, for up to three children, depending on your family size and income. Additional children are covered at no extra premium.

Eligibility

Before requesting an application, please read below to see if your children qualify.

Your children may be eligible for Kaiser Permanente Child Health Plan if they:

  • are under 19 years of age (birth through age 18) and not currently insured
  • are not eligible for public health care coverage such as Medi-Cal or Healthy Families (see our Useful resources page to get contact information for these programs)
  • are not eligible for health care coverage that is paid for, in any part, by an employer
  • are in a family with an annualized income‡ between the ranges shown below
$8 per child*† $15 per child*†
Family size
(parents & children)
Annualized income‡ before taxes is between: Annualized income‡ before taxes is between:
1 $0 to $27,075 $27,076 to $32,490
2 $0 to $36,425 $36,426 to $43,710
3 $0 to $45,775 $45,776 to $54,930
4 $0 to $55,125 $55,126 to $66,150
5 $0 to $64,475 $64,476 to $77,370
6 $0 to $73,825 $73,826 to $88,590
7 $0 to $83,175 $83,176 to $99,810
8 $0 to $92,525 $92,526 to $111,030
For each
additional person
add $9,350 add $11,220

Ranges shown above are subject to change.

In the chart above, a family size of one means a parent is requesting coverage for a child who does not live with him or her. A single parent who lives with one child counts as a family of two.

*Monthly premium per child, up to three children. Additional children are covered at no extra premium.

†If your income is within the ranges in this column and you are eligible for Medi-Cal or Healthy Families, please apply to those plans first before you apply for our plan.

‡Annualized income is your projected income for one year, based on the total monthly household gross income information you submit with your application.

Benefits

April 1, 2010 through April 1, 2011

Kaiser Permanente Child Health Plan is a quality health plan at an affordable price. If your child qualifies, coverage includes the following:

Benefit Copayment
Doctor office visits $5
Prescriptions $5 generic/$20 brand name (100-day supply)
Urgent care $5
Emergency visits $35
Hospital care No charge
Hearing and vision tests $5
Laboratory/X-ray services No charge
Mental health care Outpatient: $5 per individual therapy visit; up to 20 visits per calendar year
Inpatient: no charge; up to 30 days per calendar year
Eyeglasses $125 allowance for pair of eyeglasses every 24 months
Copayment maximum
per calendar year
$250 per child/$500 for two or more children

Dental coverage for Kaiser Permanente Child Health Plan is offered to all our Child Health Plan members at no additional premium. The DeltaCare program is administered by PMI, the HMO affiliate of Delta Dental.

FAQ on Child Only Plans

What is the difference between Child Health Plan and the Healthy Families Program?

The Healthy Families Program is offered by the state of California and provides comprehensive health care coverage to most uninsured children (under 19 years of age) whose families earn up to 300 percent of the income eligibility guidelines and who are not eligible for no-cost Medi-Cal. Kaiser Permanente is one of many health plans that participate as a provider in the Healthy Families Program. If your children are eligible for Healthy Families, we encourage you to apply for that plan before you apply to Child Health Plan.

Kaiser Permanente Child Health Plan is our own health plan designed to enroll uninsured children whose families earn up to 300 percent of the income eligibility guidelines and who do not qualify for any government-sponsored programs (such as Medi-Cal or Healthy Families).

Which services are not covered by Child Health Plan?

Our summary of benefits highlights some of the covered benefits. Services not covered can be found in the Membership Agreement and Disclosure Form and Evidence of Coverage booklet contained in Child Health Plan enrollment kit.

Examples of services not covered include the following:

  • chiropractic services
  • contact lens examinations, fitting, and dispensing
  • refractive eye surgery

Is a medical review required as part of the Child Health Plan application?

No, a medical review or exam is not required to sign up for Child Health Plan. In other words, pre-existing conditions will not disqualify an applicant.

Is my child’s Social Security number required on the Child Health Plan application?

Your child’s Social Security number is requested but not required on the Child Health Plan application. This information is confidential and will not be shared.

Will I need to recertify my child for Child Health Plan?

Yes, recertification is necessary every 2 years for continued Child Health Plan membership. Children accepted for enrollment are eligible for membership in Child Health Plan for a period of 24 months. A few months before the 24th month, you will be asked to complete a recertification application and submit updated proof of income. If approved, your child may continue the Child Health Plan membership for another year of coverage.

What are the copayment limits for Child Health Plan, and what should I do when my copayment limit has been reached?

The copayment limit for the year is $250 for one child, and $500 for two children or more. When you pay a copayment, always ask for a receipt. When you reach the copayment limit, bring your receipts to the business office at your local Kaiser Permanente medical center. You will receive a card to show that no more copayments are due for the remainder of the calendar year.

My spouse and I receive health care coverage through our employers. However, our employers do not cover our child. Is my child still eligible for CHP?

Yes.

Once my child is enrolled under Child Health Plan, can I use any doctors who are not with Kaiser Permanente?

You must access services for your child at Kaiser Permanente facilities. However, there are exceptions—please refer to the Child Health Plan Membership Agreement and Disclosure Form and Evidence of Coverage booklet contained in the Kaiser Permanente Child Health Plan enrollment kit for details.
Is there an application fee for Child Health Plan?

There is no application fee.