KIDCARE MEMBER HANDBOOK

KIDCARE MEMBER HANDBOOK KC 3793 (N-3-02)

THIS HANDBOOK IS ONLY FOR CHILDREN AND PREGNANT WOMEN. IF YOU ARE AN ADULT AND NOT PREGNANT, YOU SHOULD CALL YOUR ILLINOIS DEPARTMENT OF HUMAN SERVICES (DHS) LOCAL OFFICE ABOUT MEDICAL COVERAGE, REPORTING CHANGES AND ANY QUESTIONS THAT YOU HAVE. LEARN THE NUMBER OF YOUR DHS LOCAL OFFICE.

THIS KIDCARE MEMBER HANDBOOK IS FOR YOU! MAKE THE MOST OF KIDCARE AND USE YOUR HANDBOOK! It contains valuable information about KidCare health benefits and services for children age 18 or younger and for pregnant women. The Handbook talks about the KidCare Plans gives tips on keeping healthy lists helpful ideas for pregnant women has guidelines for using KidCare benefits and getting additional service includes steps to getting health care tells how to take care of problems The Handbook has many special features starting on page 76: a personal KidCare information sheet charts for keeping track of shots (vaccinations) and checkups definitions of words you need to know important phone numbers and websites information on interpreters, KidCare numbers and the KidCare website Please take time to look at the KidCare Member Handbook. Be sure you know how KidCare can help to keep you and your children healthy! Call the KidCare hotline toll-free at 1-866-4-OUR-KIDS (1-866-468-7543) (TTY: 1-877-204-1012) 1

Your Guide To The KidCare Handbook Part 1. Welcome To KidCare (pp. 3-4) What Is KidCare? Health Care Through KidCare Part 2. KidCare Health Plans (pp. 5-34) KidCare Assist KidCare Moms & Babies KidCare Share KidCare Premium KidCare Rebate Medical Bills Before You Applied For KidCare Renewal Part 5. Using Your KidCare Benefits (pp. 50-55) Finding A Personal Doctor Specialists Immediate Care Or Urgent Care Emergency Care Family Planning Transportation To Medical Care Mental Health And Substance Abuse Part 6. Other Services/Benefits (pp. 56-58) Family Case Management WIC Child Support Part 3. KidCare Health Services (pp. 35-43) KidCare Advantage Personal Doctor Preventive Health Care Medical Services Checkup Visits Children And Their Shots Dental Services Vision (Eye) Services How To Get Help You Need Children With Special Health Care Needs Part 4. KidCare For Pregnant (pp. 44-49) Women Health Care Right Away Prenatal Care Your Baby Part 7. How To Get Medical Care (p.59) Part 8. Taking Care Of Problems (pp. 60-75) Complaints Appeals & Fair Hearings Grievances Civil Rights Fraud And Abuse Part 9. Special Features (pp. 76-86) Personal Information Sheet Children And Their Shots Chart To Keep Track Of Checkups Words You Need To Know Important Phone Numbers And Websites Information On Interpreters, KidCare Numbers And KidCare Website Notes 2 Call the KidCare hotline toll-free at 1-866-4-OUR-KIDS (1-866-468-7543) (TTY: 1-877-204-1012)

KIDCARE - KEEPING YOUR KIDS HEALTHY PART 1. WELCOME TO KIDCARE What Is KidCare? KidCare is a health insurance program. KidCare helps pay for health care for children 18 or younger and pregnant women who live in Illinois. KidCare may pay a rebate to families who already have health insurance for their children. (Rebate: families receive money to help pay health insurance premiums for their children.) KidCare is a program of the Illinois Department of Public Aid (DPA). Health Care Through KidCare: Many doctors and other health care providers accept KidCare insurance. With KidCare, you decide where to go to get health care. Remember to be sure the doctors and other health care providers accept KidCare. Tell them I have KidCare insurance. Do you take KidCare? If your children see a doctor or health care provider that does not accept KidCare, you have to pay the bill. If you need help finding a doctor or health care provider, call the KidCare hotline toll-free at 1-866-4-OUR-KIDS (1-866-468-7543) (TTY: 1-877-204-1012). Monday-Friday 8:00 a.m. - 6:00 p.m. If you are in a managed care plan (Americaid, Harmony Health Plan, Humana Health Plan, United Health Care of Illinois, Family Health Network), call the managed care plan for help in getting a doctor or health care provider from its list. See page 59 for more on a managed care plan. Call the KidCare hotline toll-free at 1-866-4-OUR-KIDS (1-866-468-7543) (TTY: 1-877-204-1012) 3

KIDCARE - KEEPING YOUR KIDS HEALTHY KidCare Plans: There are five KidCare Plans KidCare Assist KidCare Moms & Babies KidCare Share KidCare Premium KidCare Rebate A person can only be enrolled in one plan at a time. Each plan has its own rules. Read the rules for your plan on the following pages. 4 Call the KidCare hotline toll-free at 1-866-4-OUR-KIDS (1-866-468-7543) (TTY: 1-877-204-1012)

KIDCARE ASSIST KIDCARE - KEEPING YOUR KIDS HEALTHY PART 2. KIDCARE HEALTH PLANS KidCare Assist an adult Health Care For Children 18 Or Younger If you are an adult, you should call your local office about medical coverage, reporting changes and any questions that you have. Benefits: KidCare Assist pays for covered medical services. See Part 3 and Part 5 to learn how to get health care for your children. Contact Office: Call your Department of Human Services (DHS) Local Office if you have questions about KidCare Assist. If you don t know the number, call the KidCare hotline toll-free at 1-866-4-OUR-KIDS (1-866-468-7543) (TTY: 1-877-204-1012). I.D. Cards: You get a new MediPlan Card every month. Keep the MediPlan Card. You must show it to doctors or health care providers when your children get health care. Do not give the MediPlan Card to anyone. The MediPlan Card is printed on white paper. The front of the card lists a case I.D. number and dates the MediPlan Card covers. The back of the card gives the names and birth dates of all family members who get KidCare. An individual I.D. number is listed next to the name of each person. This number is used by doctors and health care providers to bill KidCare. Report any errors that you notice on the card to your DHS Local Office. See sample MediPlan Card on next page. If you lose your MediPlan Card or you do not get one at the beginning of the month, call your DHS Local Office. Call the KidCare hotline toll-free at 1-866-4-OUR-KIDS (1-866-468-7543) (TTY: 1-877-204-1012) 5

KIDCARE - KEEPING YOUR KIDS HEALTHY KIDCARE ASSIST Front of KidCare Assist MediPlan Card: State of Illinois - Department of Public Aid MediPlan Case ID Number Eligibility Period 94 199 00 Doe, 011111 Jane R 09-01-01 Through 09-31-01 CASELOAD Z99 X IMAGINARY, JANE DOE 45 ANYPLACE ROAD YOUR TOWN, IL 60000. 9999999 DPA 469KC (R-1-90) 11-082501 IL 487-0234 Note: The seal of the State of Illinois appears in blue ink in the spot marked with a large X in a circle. Back of KidCare Assist MediPlan Card: Eligibility Period 09-01-01 Through 09-30-01 Case ID Number 94 199 00 011111 00000111 IMAGINARY, JANE DOE 45 ANYPLACE ROAD YOUR TOWN, IL ONLY THE FOLLOWING PERSONS ARE ELIGIBLE: IMOGENE IMAGINARY ID#: 222222222 DOB: 05/06/90 MEDICAID FANTASY IMAGINARY ID#: 333333333 DOB: 06/03/95 MEDICAID TPL: A001 ****************************************************************************** TOTAL NUMBER OF COVERED PERSONS: 2 13-082501 -Please see front of card for important information- x 6 Call the KidCare hotline toll-free at 1-866-4-OUR-KIDS (1-866-468-7543) (TTY: 1-877-204-1012)

KIDCARE ASSIST KIDCARE - KEEPING YOUR KIDS HEALTHY Length Of Coverage: KidCare Assist may continue up to one year at a time. Your Department of Human Services (DHS) Local Office contacts you near the end of one year to renew your coverage. See pages 26 28 for more information on this. Changes To Report: You can report changes by phone, letter or in person. You must tell your DHS Local Office in 10 days if these changes happen. You move The MediPlan Card is not automatically forwarded with your other mail. Anyone who gets KidCare moves out of Illinois, dies, or goes to jail or prison Your children may get medical benefits longer if you tell your DHS Local Office when Your family s income goes down The number of family members living with you goes up You should also tell your DHS Local Office If your children s health insurance changes or they begin getting health insurance Someone in your family gets pregnant Medical Bills: There are no co-payments or premiums for KidCare Assist. If you get a bill while your children are covered by KidCare Assist, call the doctor or health care provider. Tell them you have KidCare Assist. Give them the information on your MediPlan Card. If you keep getting the bill, call your DHS Local Office or the KidCare hotline toll-free at 1-866-4-OUR-KIDS (1-866-468-7543) (TTY: 1-877-204-1012). NOTE: You do not have to go to your DHS Local Office about your KidCare coverage. Everything can be handled by phone or mail. Call the KidCare hotline toll-free at 1-866-4-OUR-KIDS (1-866-468-7543) (TTY: 1-877-204-1012) 7

KIDCARE - KEEPING YOUR KIDS HEALTHY KIDCARE MOMS & BABIES KidCare Moms & Babies Health Care For Pregnant Women And Their Babies Up To 12 Months Of Age Benefits: KidCare Moms & Babies pays for covered medical services. See Part 3 and Part 5 to learn how to get health care. Contact Office: I.D. Cards: Call your Department of Human Services (DHS) Local Office if you have questions about KidCare Moms & Babies. If you don t know the number, call the KidCare hotline toll-free at 1-866-4-OUR-KIDS (1-866-468-7543) (TTY: 1-877-204-1012). You get a new MediPlan Card every month. Keep the MediPlan Card. You must show it to doctors or health care providers when you or your baby get health care. Do not give the MediPlan Card to anyone. The MediPlan Card is printed on white paper. The front of the card lists the case I.D. number and dates the MediPlan Card covers. The back of the card gives the names and birth dates of all family members who get KidCare. An individual I.D. number is listed next to the name of each person. This number is used by doctors and health care providers to bill KidCare. Report any errors that you notice on the card to your DHS Local Office. See sample MediPlan Card on next page. If you lose your MediPlan Card or you do not get one at the beginning of the month, call your DHS Local Office. 8 Call the KidCare hotline toll-free at 1-866-4-OUR-KIDS (1-866-468-7543) (TTY: 1-877-204-1012)

KIDCARE MOMS & BABIES KIDCARE - KEEPING YOUR KIDS HEALTHY Front of KidCare Moms & Babies MediPlan Card: State of Illinois - Department of Public Aid MediPlan Case ID Number Eligibility Period 94 199 00 Doe, 011111 Jane R 09-01-01 Through 09-31-01 CASELOAD Z99 X IMAGINARY, JANE DOE 45 ANYPLACE ROAD YOUR TOWN, IL 60000. 9999999 DPA 469 (R-1-90) 11-082501 IL 487-0234 Note: The seal of the State of Illinois appears in blue ink in the spot marked with a large X in a circle. Back of KidCare Moms & Babies MediPlan Card: Eligibility Period 09-01-01 Through 09-30-01 Case ID Number 94 199 00 011111 00000111 IMAGINARY, JANE DOE 45 ANYPLACE ROAD YOUR TOWN, IL Length Of ONLY THE FOLLOWING PERSONS ARE ELIGIBLE: JANE D. IMAGINARY ID#:111111111 DOB: 09/28/81 MEDICAID *********************************************************************** TOTAL NUMBER OF COVERED PERSONS: 1 x 13-082501 -Please see front of card for important information- Call the KidCare hotline toll-free at 1-866-4-OUR-KIDS (1-866-468-7543) (TTY: 1-877-204-1012) 9

KIDCARE - KEEPING YOUR KIDS HEALTHY KIDCARE MOMS & BABIES Length Of Coverage: Once approved, you are covered until two months after you are no longer pregnant. If you are pregnant and 18 or younger, coverage may continue for 12 months from the first month of coverage. If you are enrolled in KidCare when your baby is born, your baby receives KidCare health benefits for one year from the date of birth. See pages 26-29 for more information on this. Changes To Report: You can report changes by phone, letter or in person. You must tell your Department of Human Services (DHS) Local Office in 10 days when and if these changes happen. You are no longer pregnant You move The MediPlan Card is not automatically forwarded with your other mail. Anyone who gets KidCare moves out of Illinois, dies, or goes to jail or prison You may get medical benefits longer if you tell your DHS Local Office when Your family s income goes down The number of family members living with you goes up You should tell your DHS Local Office if your or your baby s other health insurance changes. Remember, you should call your DHS Local Office or call the KidCare hotline toll-free at 1-866-4-OUR-KIDS (1-866-468-7543) (TTY: 1-877-204-1012) to report when the baby is born, the baby s name, whether it is a boy or girl, the date of birth and if the baby has any other health insurance. 10 Call the KidCare hotline toll-free at 1-866-4-OUR-KIDS (1-866-468-7543) (TTY: 1-877-204-1012)

KIDCARE MOMS & BABIES KIDCARE - KEEPING YOUR KIDS HEALTHY Medical Bills: There are no co-payments or premiums for KidCare Moms & Babies. If you get a bill while you or your baby are covered by KidCare Moms & Babies, call the doctor or health care provider. Tell them you have KidCare Moms & Babies. Give them the information on your MediPlan Card. If you keep getting the bill, call your Department of Human Services (DHS) Local Office or the KidCare hotline toll-free at 1-866-4-OUR-KIDS (1-866-468-7543) (TTY: 1-877-204-1012). NOTE: You do not have to go to your DHS Local Office about your KidCare coverage. Everything can be handled by phone or mail. Call the KidCare hotline toll-free at 1-866-4-OUR-KIDS (1-866-468-7543) (TTY: 1-877-204-1012) 11

KIDCARE SHARE KidCare Share Health Care For Uninsured Children 18 Or Younger Benefits: KidCare Share covers a wide range of health care services. You pay a share of your children s health care costs because you pay copayments for some medical services. See Part 3 and Part 5 to learn how to get health care for your children. Contact Office: I.D. Cards: Call the central KidCare Unit in Springfield toll-free at 1-877-805-5312 if you have questions about KidCare Share. You get a new KidCare I.D. Card every month. Keep the KidCare I.D. Card. You must show it to doctors or health care providers when your children get health care. Do not give the KidCare I.D. Card to anyone. The KidCare I.D. Card is printed on yellow paper. The front of the card lists the case I.D. number, dates the KidCare I.D. Card covers and co-payments you must pay. The back of the card gives the names and birth dates of all children who get KidCare. An individual I.D. number is listed next to the name of each child. This number is used by doctors and health care providers to bill KidCare. Report any errors that you notice on the card to the central KidCare Unit. See sample KidCare Share I.D. Card on next page. If you lose your KidCare I.D. Card or you do not get one at the beginning of the month, call the central KidCare Unit. 12 Call the KidCare hotline toll-free at 1-866-4-OUR-KIDS (1-866-468-7543) (TTY: 1-877-204-1012)

KIDCARE SHARE KIDCARE KEEPING YOUR KIDS HEALTHY Front of KidCare Share Insurance Card: State of More KidCare Information: Illinois Call 1-866-4-OUR-KIDS 0006892F 1-866-468-7543 (TTY: 1-877-204-1012) Case ID Number Coverage Period 94 180 00 W99999 09-01-2001 Through 09-30-2001 CASELOAD: 091. Doe, Jane RPY 123 Main Street Springfield, IL 60000. PROVIDERS MAY COLLECT A CO-PAY FOR CERTAIN SERVICES. CO-PAYS ARE $2.00 FOR DRUG PRESCRIPTION AND CERTAIN TYPES OF MEDICAL VISITS. NO CO-PAYS FOR IMMUNIZATIONS, WELL-CHILD VISITS, LAB AND RADIOLOGY SERVICES. DPA 469KC (R-7-98) KC-08252001 IL 478-0234 Back of KidCare Share Insurance Card. Coverage Period 09-01-2001 Through 09-30-2001 DOE, JANE RPY 123 Main Street Springfield, IL 60000 Case ID Number: 94 180 W99999 ADDRESS CHANGED? CALL 1-866-4-OUR-KIDS 0006892B 1-866-468-7543 RIGHT AWAY (TTY: 1-877-204-1012) ONLY THE FOLLOWING PERSONS ARE COVERED BOBBY DOE ID#: 222222222 DOB: 01/01/90 CINDY SMITH ID#: 333333333 DOB: 01/01/92 ****************************************************************************** TOTAL NUMBER OF COVERED PERSONS: 2 KC-08252001- Please see front of card for important information- Call the KidCare hotline toll-free at 1-866-4-OUR-KIDS (1-866-468-7543) (TTY: 1-877-204-1012) 13

KIDCARE SHARE Length Of Coverage: KidCare Share may continue up to one year at a time. KidCare contacts you near the end of one year to renew your coverage. See pages 32-34 for more information on this. Changes To Report: You can report changes by phone, letter or in person. You must tell the central KidCare Unit in 10 days when these changes happen. You move Anyone who gets KidCare moves out of Illinois, dies, or goes to jail or prison Any of your children begin getting insurance Your children may get medical benefits longer if you tell the central KidCare Unit when Your family s income goes down The number of family members living with you goes up You should also tell the central KidCare Unit when someone in your family gets pregnant. Call the central KidCare Unit in Springfield toll-free at 1-877-805-5312 to report changes. If you want to add children to KidCare, call the central KidCare Unit. Co-payments: You may be charged a co-payment at a doctor s or a health care provider s office when your children get health care. Co-payment amounts are $2.00 for each doctor, dentist or other health care visit when your children are sick $2.00 for each emergency room visit in an emergency and in a non-emergency $2.00 for each prescription There are no co-payments for well-child visits including visits for shots (vaccinations) and checkups for children. There are no copayments for lab tests or x-rays. 14 Call the KidCare hotline toll-free at 1-866-4-OUR-KIDS (1-866-468-7543) (TTY: 1-877-204-1012)

KIDCARE SHARE KIDCARE KEEPING YOUR KIDS HEALTHY The doctor or health care provider may refuse to see your children if you don t pay your co-payment. Some doctors and health care providers do not charge co-payments. Families with children who are American Indians or Alaska Natives do not have to pay co-payments. You do not have to pay co-payments after you have paid $100.00 in co-payments in a year for your children who are in KidCare Share or Premium. KidCare mailed a Co-payment Tracking Form to you to keep track of the co-payments you make. If you didn t get one, call the central KidCare Unit in Springfield toll-free at 1-877-805-5312. If your co-payments reach $100.00 during the enrollment year, send your receipts to the central KidCare Unit in the Co-payment Tracking Form envelope. After the central KidCare Unit gets your receipts showing you paid $100 in co-payments, you get a letter showing that your copayment is now $0.00. Your next KidCare I.D. Card also shows $0.00 co-payment for the rest of your 12-month coverage period. Medical Bills: There are no premiums. If you get a bill while your children are covered by KidCare Share, call the doctor or health care provider. Tell them you have KidCare Share. Give them the information on your KidCare I.D. Card. If you keep getting the bill, call the KidCare hotline toll-free at 1-866-4-OUR-KIDS (1-866-468-7543) (TTY: 1-877-204-1012). If you have medical bills for your children before they were covered by KidCare that you want help with, see Prior Coverage on pages 24 and 25. Call the KidCare hotline toll-free at 1-866-4-OUR-KIDS (1-866-468-7543) (TTY: 1-877-204-1012) 15

KIDCARE PREMIUM KidCare Premium Health Care For Uninsured Children 18 Or Younger Benefits: KidCare Premium covers a wide range of health care services. You pay a monthly premium for KidCare and you pay co-payments for some medical services. See Part 3 and Part 5 to learn how to get health care for your children. Contact Office: Call the central KidCare Unit in Springfield toll-free at 1-877-805-5312 if you have questions about KidCare Premium. I.D. Cards: You get a new KidCard I.D. Card every month. Keep the KidCare I.D. Card. You must show it to doctors or health care providers when your children get health care. Do not give the KidCare I.D. Card to anyone. The KidCare I.D. Card is printed on yellow paper. The front of the card lists the case I.D. number, dates the KidCare I.D. Card covers and co-payments you must pay. The back of the card gives the names and birth dates of all children who get KidCare. An individual I.D. number is listed next to the name of each child. This number is used by doctors and health care providers to bill KidCare. Report any errors that you notice on the card to the central KidCare Unit. See sample KidCare Premium I.D. Card on next page. If you lose your KidCare I.D. Card or you do not get one at the beginning of the month, call the central KidCare Unit. 16 Call the KidCare hotline toll-free at 1-866-4-OUR-KIDS (1-866-468-7543) (TTY: 1-877-204-1012)

KIDCARE PREMIUM KIDCARE - KEEPING YOUR KIDS HEALTHY Front of KidCare Premium Insurance Card: 0006892F State of More KidCare Information: Illinois Call 1-866-4--OUR-KIDS 1-866-468-7543 (TTY: 1-877-204-1012) Case ID Number Coverage Period 94 180 00 W99999 Case ID Number 09-01-2001 Through 09-30-2001 Coverage Period CASELOAD: 091. Doe, Jane RPY 123 Main Street Springfield, IL 60000. PROVIDERS MAY COLLECT A CO-PAY FOR CERTAIN SERVICES. CO-PAYS ARE $5.00 FOR CERTAIN TYPES OF MEDICAL VISITS, $3.00 FOR GENERIC OR $5.00 FOR BRAND-NAME PRESCRIPTIONS, AND $25.00 FOR NON-EMERGANCY USE OF EMERGENCY ROOM. NO CO-PAYS FOR IMMUNIZATIONS, WELL-CHILD VISITS, LAB AND RADIOLOGY SERVICES. DPA 469KC (R-7-98) KC-08252001 IL 478-0234 Back of KidCare Premium Insurance Card: Coverage Period 09-01-2001 Through 09-30-2001 DOE, JANE RPY 123 Main Street Springfield, IL 60000 Case ID Number 94-180-W99999 ADDRESS CHANGED? CALL 1-866-4-OUR-KIDS 1-866-468-7543 RIGHT AWAY (TTY: 1-877-204-1012) 0006892B ONLY THE FOLLOWING PERSONS ARE COVERED: BOBBY DOE ID#: 222222222 DOB: 01/01/90 CINDY SMITH ID#: 333333333 DOB: 01/01/92 ***************************************************************** TOTAL NUMBER OF COVERED PERSONS: 2 KC-08252001 -Please see front of card for important information- Call the KidCare hotline toll-free at 1-866-4-OUR-KIDS (1-866-468-7543) (TTY: 1-877-204-1012) 17

KIDCARE - KEEPING YOUR KIDS HEALTHY KIDCARE PREMIUM Length Of Coverage: KidCare Premium may continue up to one year at a time. KidCare contacts you near the end of one year to renew your coverage. See pages 32-34 for more information on this. Changes To Report: You can report changes by phone, letter or in person. You must tell the central KidCare Unit in 10 days when these changes happen. You move Anyone who gets KidCare moves out of Illinois, dies, or goes to jail or prison Any of your children begin getting insurance Your children may get medical benefits longer if you tell the central KidCare Unit when Your family s income goes down The number of family members living with you goes up You should also tell the central KidCare Unit when someone in your family gets pregnant. Call the central KidCare Unit in Springfield toll-free at 1-877-805-5312 to report changes. If you want to add children to KidCare, call the central KidCare Unit. Co-payments: You may be charged a co-payment at a doctor s or a health care provider s office when your children get health care. Co-payment amounts are $5.00 for each doctor, dentist or other health care visit when your children are sick $3.00 for each generic prescription $5.00 for each brand name prescription $25.00 for each emergency room visit in a non-emergency $5.00 for each emergency room visit in an emergency 18 Call the KidCare hotline toll-free at 1-866-4-OUR-KIDS (1-866-468-7543) (TTY: 1-877-204-1012)

KIDCARE PREMIUM KIDCARE - KEEPING YOUR KIDS HEALTHY There are no co-payments for well-child visits including visits for shots (vaccinations) and checkups for children. There are no co-payments for lab tests or x-rays. The doctor or health care provider may refuse to see your children if you don t pay your co-payment. Some doctors and health care providers do not charge co-payments. Families with children who are American Indians or Alaska Natives do not have to pay co-payments. You do not have to pay co-payments after you have paid $100.00 in copayments in a year for your children who are in KidCare Share or KidCare Premium. KidCare mailed a Co-payment Tracking Form to you to keep track of the co-payments you make. If you didn t get one, call the central KidCare Unit in Springfield toll-free at 1-877-805-5312. If your co-payments reach $100.00 during the enrollment year, send your receipts to the central KidCare Unit in the Co-payment Tracking Form envelope. After the central KidCare Unit gets your receipts showing you paid $100 in co-payments, you get a letter showing that your copayment is now $0.00. Your next KidCare I.D. Card also shows $0.00 co-payment for the rest of your 12-month coverage. The most any KidCare family pays in a year is $460. ($100 in copayments, $360 in premiums for three or more children). Many families pay less. Monthly Premiums: With KidCare Premium, you pay a premium for your children each month even if your children do not need any health care. Monthly premiums are Call the KidCare hotline toll-free at 1-866-4-OUR-KIDS (1-866-468-7543) (TTY: 1-877-204-1012) 19

KIDCARE - KEEPING YOUR KIDS HEALTHY KIDCARE PREMIUM One child - $15.00 Two children - $25.00 Three or more children - $30.00 Families with children who are American Indians or Alaska Natives do not have to pay premiums. Each month KidCare bills you for your premium. You need to pay each bill by the due date on the bill. It is important to pay premiums on time so that KidCare does not stop for your children. If you do not pay the premiums, KidCare will be cancelled. If your coverage is cancelled because you did not pay your premiums, you must wait three months before your children can again be enrolled in KidCare Share, KidCare Premium or KidCare Rebate. All past due premiums must be paid before your children can be enrolled again. You receive a notice to pay your premium each month. The notice tells how much you owe, when the payment is due and where to send the payment. Mail your payment to Bureau of Fiscal Operations, Department of Public Aid, P.O. Box 19121, Springfield, IL 62794. You can pay the premium by personal check, money order, Visa or MasterCard. If you want to use Visa or MasterCard, call the Bureau of Fiscal Operations toll-free at 1-877-828-2375. Medical Bills: If you get a bill while your children are covered by KidCare Premium, call the doctor or health care provider. Tell them you have KidCare Premium. Give them the information on your KidCare I.D. Card. If you keep getting the bill, call the KidCare hotline toll-free at 1-866-4-OUR-KIDS (1-866-468-7543) (TTY: 1-877-204-1012). If you have medical bills for your children before they were covered by KidCare that you want help with, see Prior Coverage on pages 24 and 25. 20 Call the KidCare hotline toll-free at 1-866-4-OUR-KIDS (1-866-468-7543) (TTY: 1-877-204-1012)

KIDCARE REBATE KIDCARE - KEEPING YOUR KIDS HEALTHY KidCare Rebate Payments For Children 18 Or Younger With Health Insurance Benefits: KidCare pays the policyholder a rebate to cover some of the costs of the premiums for the children s insurance. The policyholder is the person to whom a health insurance policy covering a child is issued. KidCare Rebate can pay for some or all of the health insurance premiums you pay for your children. KidCare Rebate pays the policyholder up to $75.00 per child per month for their health insurance premium cost. The policyholder pays all premiums owed to an employer or insurance company for the children s coverage. The KidCare Rebate check is paid directly to the policyholder. Your children s health benefits are set by the employer or private health insurance plan. You can get KidCare Rebate only if the children s health insurance covers doctor and inpatient hospital care. You pay for any co-payments, co-insurance or deductibles charged by the employer or private health insurance plan. Contact Office: Call the central KidCare Unit in Springfield toll-free at 1-877-805-5312 if you have questions about KidCare Rebate. I.D. Cards: Use the I.D. Card from your insurance company. You do not get an I.D. Card from KidCare. Call the KidCare hotline toll-free at 1-866-4-OUR-KIDS (1-866-468-7543) (TTY: 1-877-204-1012) 21

KIDCARE - KEEPING YOUR KIDS HEALTHY KIDCARE REBATE Length Of Coverage: KidCare Rebate may continue up to one year at a time. KidCare contacts you near the end of one year to renew your coverage. See pages 32 34 for more information on this. Changes To Report: You can report changes by phone, letter or in person. You must tell the central KidCare Unit in 10 days when these changes happen. You move The Rebate check is not automatically forwarded with your other mail Anyone who gets benefits moves out of Illinois, dies, or goes to jail or prison Someone is added to or taken off the health insurance policy or the policyholder changes The monthly health insurance premium or insurance carrier changes Your children s health insurance plan ends If these changes are not reported within 10 days you may get an overpayment. You may be asked to pay back any overpayment. It may be helpful to you to call the central KidCare Unit if these changes happen. Your family s income goes down The number of family members living with you goes up You should call the central KidCare Unit when someone in your family gets pregnant. If you want to add children to KidCare, call the central KidCare Unit in Springfield toll-free at 1-877-805-5312 to report changes. 22 Call the KidCare hotline toll-free at 1-866-4-OUR-KIDS (1-866-468-7543) (TTY: 1-877-204-1012)

KIDCARE REBATE KIDCARE - KEEPING YOUR KIDS HEALTHY If the policyholder gets Rebate checks for months when your children were not covered by health insurance, you must contact KidCare right away. (This is considered an overpayment. It must be repaid.) Payments: KidCare mails Rebate checks around the first of each month. You may go to the Illinois Office of the Comptroller s website at www.ioc.state.il.us to check the mail date of your Rebate payment. Select Vendor Payments then follow the directions. If you have any questions about your Rebate payment, please call KidCare tollfree at 1-877-805-5312. If There Is A Problem: If you do not get your Rebate check, call the central KidCare Unit toll-free at 1-877-805-5312. The central KidCare Unit can help if you are having a problem with KidCare Rebate. Read Taking Care Of Problems, pages 60 75 of this handbook and follow the directions. For all other problems you must refer to the policyholder s plan handbook, or speak to the benefits manager at the policyholder s job or speak to your insurance agent. Call the KidCare hotline toll-free at 1-866-4-OUR-KIDS (1-866-468-7543) (TTY: 1-877-204-1012) 23

If You Had Medical Bills When You Applied For KidCare, You May Get Help To Pay Them! KidCare Assist And KidCare Moms & Babies: If you had medical bills for one of the three months before you applied for KidCare or for months while your application was with KidCare, you may be able to get help. Contact your Department of Human Services (DHS) Local Office caseworker for more information. If you don t know the number, call the KidCare hotline tollfree at 1-866-4-OUR-KIDS (1-866-468-7543) (TTY: 1-877-204-1012). When you or your children are approved for coverage for KidCare Assist or KidCare Moms & Babies, the date that medical coverage begins is written in the approval letter that you get. When you or your children are approved for medical coverage, the first month of coverage can be one of the following: The month you applied, if you or your children were eligible for that month, or Up to three months before the month you applied, if you or your children were eligible for those months. KidCare Share And KidCare Premium: If you had medical bills for one of the two weeks before you applied for KidCare, you may be able to get help to pay them. 24 Call the KidCare hotline toll-free at 1-866-4-OUR-KIDS (1-866-468-7543) (TTY: 1-877-204-1012)

Contact the central KidCare Unit in Springfield tollfree at 1-877-805-5312 for more information. When your children are approved for coverage for KidCare Share or KidCare Premium, the date that medical coverage begins is written in the approval letter that you get. The first time your children are approved for KidCare Share or KidCare Premium, the children may be eligible for payment of medical services received from two weeks before the date of application until the date KidCare coverage begins. This is called prior coverage. If you want prior coverage for your children, you must request it within six months from the beginning date of KidCare Share or KidCare Premium coverage. You may request prior coverage by calling the KidCare hotline toll-free at 1-866-4-OUR-KIDS (1-866-468-7543) (TTY: 1-877-204-1012) or the central KidCare Unit in Springfield toll-free at 1-877-805-5312. You may also mail your request for prior coverage to the central KidCare Unit at P.O. Box 19122 Springfield, IL 62794-9122. You may do this by using the KidCare form or sending a letter with your request. Call the KidCare hotline toll-free at 1-866-4-OUR-KIDS (1-866-468-7543) (TTY: 1-877-204-1012) 25

Renewal KidCare Assist: At the end of one year you are contacted by your Department of Human Services (DHS) Local Office to review your children s eligibility to keep getting KidCare. See sample form, Your Family s Medical Eligibility,on the next two pages. It is important you give any information requested by your DHS Local Office. They need the information to decide if your children can still get KidCare Assist. Your DHS Local Office lets you know if your children qualify for another year of KidCare Assist or for a different KidCare plan. NOTE: If your DHS Local Office does not contact you, you remain on KidCare Assist until the renewal is completed. KidCare Moms & Babies: Pregnant Woman NOTE: You do not have to go to your DHS Local Office about your KidCare coverage. Everything can be handled by phone or mail. You must call your DHS Local Office to report when you are no longer pregnant. If you don t know the number, call the KidCare hotline toll-free at 1-866-4-OUR-KIDS (1-866-468-7543) (TTY: 1-877-204-1012). About two months after you are no longer pregnant, your DHS Local Office decides if you can get one of the other KidCare Plans. See sample form, Your Family s Medical Eligibility, on the next two pages. 26 Call the KidCare hotline toll-free at 1-866-4-OUR-KIDS (1-866-468-7543) (TTY: 1-877-204-1012)

6(PERMANENT) Your Family s Medical Eligibility Redetermination Form (Category 94/96) DATE: Case Number: LO Name: Address: We have to check if your family can still get medical benefits. We need your help. You must fill out this form and send it back to us. You must also send copies of proof of: e your family s earned and unearned income for the last 30 days, and e spousal or child support paid by your family in the last 30 days. If you do not return this form and the copies we need by, your medical benefits will end. If you need more time to complete this form and get the proofs we need, be sure to call at before then. Current Home Phone #: Current Work Phone #: Fill in the blanks below for the people now on your MediPlan card if you still want to get medical benefits for them. Name Birth Date Health insurance other than Medicaid? Name Birth Date Health insurance other than Medicaid? 9 Yes 9 No 9 Yes 9 No 9 Yes 9 No 9 Yes 9 No 9 Yes 9 No 9 Yes 9 No 9 Yes 9 No 9 Yes 9 No Below list other people who live with you. Also list their relationship to you. Include yourself, your spouse, your children not listed above, parents of children listed above, and brothers and sisters of children listed above. If you need extra space, attach another sheet of paper. Name Birth Date Relationship Name Birth Date Relationship 1. 4. 2. 5. 3. 6. Is anyone listed on this form pregnant? 9 Yes 9 No. If yes, and you have not already done so, please provide a statement from a licensed medical provider with the name of the pregnant person, expected date of delivery and the number of babies expected. DPA 643 (R-9-01) IL478-1225 Call the KidCare hotline toll-free at 1-866-4-OUR-KIDS (1-866-468-7543) (TTY: 1-877-204-1012) 27

Is any adult or minor parent listed on this form currently employed? 9 Yes 9 No If yes, complete the following: Is anyone self-employed? 9 Yes 9 No Name of Person Employer Number of hours worked weekly Amount paid (before taxes) $ How often paid Name of Person Employer Number of hours worked weekly Amount paid (before taxes) $ How often paid ENCLOSE PAYSTUBS OR SELF-EMPLOYMENT RECORDS FOR ALL EMPLOYED PERSONS FOR THE LAST 30 DAYS Is anyone listed on this form RECEIVING money from any source other than employment (such as from social security, child support, rental property, unemployment benefits, pension, trusts, etc.)? 9Yes 9 No If yes, complete the following: Name of person Source Monthly Amount $ Name of person Source Monthly Amount $ ALSO ENCLOSE PROOF OF THIS INCOME FOR THE LAST 30 DAYS Is anyone listed on this form PAYING ordered spousal or child support? 9 Yes 9 No If yes, complete the following: Name of person Monthly Amount $ Name of person Monthly Amount $ ALSO ENCLOSE PROOF OF THIS PAYMENT FOR THE LAST 30 DAYS Is anyone listed on this form PAYING for day care so they can work? 9 Yes 9 No If yes, complete the following: Name of child(ren) in day care Name of Care Giver Person paying day care Monthly Amount $ Relationship of Care Giver to Child (if any) CHECK TO MAKE SURE YOU ANSWERED ALL THE QUESTIONS AND RETURNED THE NECESSARY PROOF Officials with responsibilities for the medical benefits program which I or the members of my household receive may verify all information on this form. I understand that I must cooperate in these efforts to verify information. I understand that verification may occur through electronic means. I understand that anyone who knowingly misuses the health benefits card issued by the State of Illinois may be committing a crime. I understand that if I have given false information or intentionally failed to disclose information for this application, I may be subject to criminal prosecution, civil action or both. I certify under the penalty of perjury that the information I have provided on this application form is the truth to the best of my knowledge. Signature Today s Date 28 Call the KidCare hotline toll-free at 1-866-4-OUR-KIDS (1-866-468-7543) (TTY: 1-877-204-1012)

It is important you give any information requested by your Department of Human Services (DHS) Local Office. They need the information to decide if you can still get KidCare. NOTE: If your DHS Local Office does not contact you, you remain on KidCare Moms & Babies until the renewal is completed. NOTE: You do not have to go to your DHS Local Office about your KidCare coverage. Everything can be handled by phone or mail. New Baby After the baby is one year old, you are contacted by your DHS Local Office to decide if your baby can get one of the other KidCare Plans. See sample form, Your Family s Medical Eligibility, on the next two pages. It is important that you give any information requested by your DHS Local Office. They need the information to decide if your baby can get another KidCare Plan. Your DHS Local Office lets you know if your baby can get another KidCare Plan. NOTE: If your DHS Local Office does not contact you, your baby remains on KidCare Moms & Babies until the renewal is completed. NOTE: You do not have to go to your DHS Local Office about your KidCare coverage. Everything can be handled by phone or mail. Call the KidCare hotline toll-free at 1-866-4-OUR-KIDS (1-866-468-7543) (TTY: 1-877-204-1012) 29

6(PERMANENT) Your Family s Medical Eligibility Redetermination Form (Category 94/96) DATE: Case Number: LO Name: Address: We have to check if your family can still get medical benefits. We need your help. You must fill out this form and send it back to us. You must also send copies of proof of: e your family s earned and unearned income for the last 30 days, and e spousal or child support paid by your family in the last 30 days. If you do not return this form and the copies we need by, your medical benefits will end. If you need more time to complete this form and get the proofs we need, be sure to call at before then. Current Home Phone #: Current Work Phone #: Fill in the blanks below for the people now on your MediPlan card if you still want to get medical benefits for them. Name Birth Date Health insurance other than Medicaid? Name Birth Date Health insurance other than Medicaid? 9 Yes 9 No 9 Yes 9 No 9 Yes 9 No 9 Yes 9 No 9 Yes 9 No 9 Yes 9 No 9 Yes 9 No 9 Yes 9 No Below list other people who live with you. Also list their relationship to you. Include yourself, your spouse, your children not listed above, parents of children listed above, and brothers and sisters of children listed above. If you need extra space, attach another sheet of paper. Name Birth Date Relationship Name Birth Date Relationship 1. 4. 2. 5. 3. 6. Is anyone listed on this form pregnant? 9 Yes 9 No. If yes, and you have not already done so, please provide a statement from a licensed medical provider with the name of the pregnant person, expected date of delivery and the number of babies expected. DPA 643 (R-9-01) IL478-1225 30 Call the KidCare hotline toll-free at 1-866-4-OUR-KIDS (1-866-468-7543) (TTY: 1-877-204-1012)

Is any adult or minor parent listed on this form currently employed? 9 Yes 9 No If yes, complete the following: Is anyone self-employed? 9 Yes 9 No Name of Person Employer Number of hours worked weekly Amount paid (before taxes) $ How often paid Name of Person Employer Number of hours worked weekly Amount paid (before taxes) $ How often paid ENCLOSE PAYSTUBS OR SELF-EMPLOYMENT RECORDS FOR ALL EMPLOYED PERSONS FOR THE LAST 30 DAYS Is anyone listed on this form RECEIVING money from any source other than employment (such as from social security, child support, rental property, unemployment benefits, pension, trusts, etc.)? 9Yes 9 No If yes, complete the following: Name of person Source Monthly Amount $ Name of person Source Monthly Amount $ ALSO ENCLOSE PROOF OF THIS INCOME FOR THE LAST 30 DAYS Is anyone listed on this form PAYING ordered spousal or child support? 9 Yes 9 No If yes, complete the following: Name of person Monthly Amount $ Name of person Monthly Amount $ ALSO ENCLOSE PROOF OF THIS PAYMENT FOR THE LAST 30 DAYS Is anyone listed on this form PAYING for day care so they can work? 9 Yes 9 No If yes, complete the following: Name of child(ren) in day care Name of Care Giver Person paying day care Monthly Amount $ Relationship of Care Giver to Child (if any) CHECK TO MAKE SURE YOU ANSWERED ALL THE QUESTIONS AND RETURNED THE NECESSARY PROOF Officials with responsibilities for the medical benefits program which I or the members of my household receive may verify all information on this form. I understand that I must cooperate in these efforts to verify information. I understand that verification may occur through electronic means. I understand that anyone who knowingly misuses the health benefits card issued by the State of Illinois may be committing a crime. I understand that if I have given false information or intentionally failed to disclose information for this application, I may be subject to criminal prosecution, civil action or both. I certify under the penalty of perjury that the information I have provided on this application form is the truth to the best of my knowledge. Signature Today s Date Call the KidCare hotline toll-free at 1-866-4-OUR-KIDS (1-866-468-7543) (TTY: 1-877-204-1012) 31

KidCare Share KidCare Premium KidCare Rebate: The renewal process for KidCare Share, KidCare Premium and KidCare Rebate is the same. Near the end of the one-year coverage period, you get a renewal form in the mail. KidCare uses this form to decide if your children can still get KidCare. See sample form, Renewal of Eligibility, on the next two pages. Complete and return the form. It is important you give any information requested by the central KidCare Unit. KidCare needs this information to decide if your children can stay in KidCare. The central KidCare Unit lets you know if your children qualify for another year of KidCare Share, KidCare Premium, KidCare Rebate or if they qualify for a different KidCare Plan. NOTE: If you do not get a renewal form by the 11 th month of coverage, call the central KidCare Unit in Springfield tollfree at 1-877-805-5312. Coverage ends after the 12th month if the renewal process is not completed. 32 Call the KidCare hotline toll-free at 1-866-4-OUR-KIDS (1-866-468-7543) (TTY: 1-877-204-1012)

RENEWAL OF ELIGIBILITY April 23, 2002 KidCare Unit P. O. Box 19122 Springfield, IL 62794-9122 KidCare #: 9 - - Your children s eligibility for KidCare must be renewed once a year. You must complete this form and return proof of your family s income (earned and unearned), and court-ordered spousal and /or child support paid. Please return this information by to ensure that your children's benefits will continue without interruption. You must also return the completed and signed Rebate form with this form. Please type or print in ink. If more space is needed to answer any question, please attach an extra sheet. Is the above still your mailing address? Yes No. If no, what is your new mailing address? New Address Phone Number Following are the names of the children for whom you are receiving KidCare. Check whether or not they still live with you and whether or not they have health insurance. Do they Name of Child Birth Date Do they still live with you? have health insurance other than KidCare? Yes No If no, when did they move out? Yes No Yes No If no, when did they move out? Yes No Yes No If no, when did they move out? Yes No Yes No If no, when did they move out? Yes No Yes No If no, when did they move out? Yes No Yes No If no, when did they move out? Yes No Yes No If no, when did they move out? Yes No List the following persons not listed above who also live with you. Also list their relationship to you. Include yourself, your spouse, children not listed above, legal parents of children listed above, and siblings of children listed above. If you need extra space, attach another sheet of paper. Name Relationship Date of Birth Name Relationship Date of Birth 1. Self 4. 2. 5. 3. 6. KC 643KC (R-8-00) KC Rep # IL478-1360 Call the KidCare hotline toll-free at 1-866-4-OUR-KIDS (1-866-468-7543) (TTY: 1-877-204-1012) 33

Is anyone listed on this form pregnant? Yes No. If yes, please provide a statement from a licensed medical provider with the name of the pregnant person, expected date of delivery and the number of births. Is any parent, step-parent or spouse listed on this from currently employed? Yes No If yes, complete the following: Is anyone self-employed? Yes No Name of Person Employer Employer Address Employer Phone Number of hours worked weekly Amount paid (before taxes) $ How often paid Name of Person Employer Employer Address Employer Phone Number of hours worked weekly Amount paid (before taxes) $ How often paid ENCLOSE PAYSTUBS OR SELF-EMPLOYMENT RECORDS FOR ALL EMPLOYED PERSONS FOR THE LAST 30 DAYS Is anyone listed on this form RECEIVING money from any source other than employment (such as from social security, child support, rental property, unemployment benefits, pension, trusts)? Yes No If yes, complete the following: Name of person Source Monthly Amount $ Name of person Source Monthly Amount $ ALSO ENCLOSE PROOF OF THIS INCOME FOR THE LAST 30 DAYS Is any parent, step-parent or spouse listed on this form PAYING ordered spousal or child support? Yes No If yes, complete the following: Name of person Monthly Amount $ Name of person Monthly Amount $ ALSO ENCLOSE PROOF OF THIS PAYMENT FOR THE LAST 30 DAYS Is any parent, step-parent or spouse listed on this form PAYING for day care so they can work? Yes No If yes, complete the following: Name of child(ren) in day care Name of Care Giver Person paying day care Monthly Amount $ Relationship of Care Giver to Child (if any) Check to make sure you answered all the questions and returned the necessary proofs. Officials with responsibilities for the health benefits program for which I or the members of my household are receiving may verify all information on this form. I understand that I must cooperate in these efforts to verify information. I understand that verification may occur through electronic means. I understand that anyone who knowingly lies or misrepresents the truth or arranges for someone to knowingly lie or misrepresent the truth or intentionally misuses the health benefits card issued by the State of Illinois may be committing a crime which can be prosecuted or punished under federal law, state law or both. I certify under penalty of perjury that the information I have provided on this application form is the truth to the best of my knowledge. Signature 34 Today s Date If you have any questions, please call us at 1-877-805-5312. Call the KidCare hotline toll-free at 1-866-4-OUR-KIDS (1-866-468-7543) (TTY: 1-877-204-1012)

PART 3. KIDCARE SERVICES TO KEEP HEALTHY The KidCare Advantage: KidCare covers most medical services pregnant women and children need. KidCare serves you better if you Choose a doctor See the doctor when you or your children are sick See the doctor for checkups when you or your children are feeling good. This is called preventive health care. Personal Doctor: It is important to get a personal doctor and to use the same personal doctor as much as possible for your health care needs. A personal doctor Helps you get care for your children Provides care when your children are sick Knows your medical history and your children s medical history Keeps track of your children s shots (vaccinations) Can give you advice Refers you to a specialist when needed Helps pregnant women deliver healthy babies Answers some of your questions over the phone Can help you avoid the emergency room Keep your personal doctor s phone number handy. Preventive Health Care: KidCare preventive medical services Help your children stay healthy Help your children get all the exams and shots (vaccinations) they need Help you stay healthy if you are pregnant Help you have a healthy baby Call the KidCare hotline toll-free at 1-866-4-OUR-KIDS (1-866-468-7543) (TTY: 1-877-204-1012) 35