TABLE 3.
Key Features of Healthy Kids and Healthy Families Programs, Santa Clara and San Mateo Counties, 2004
| Healthy Kids Santa Clara County | Healthy Kids San Mateo County | Healthy Families | |
|---|---|---|---|
| Health plan | Santa Clara Family Health Plan | Health Plan of San Mateo | Various plans |
| Age group | 0–18 | 0–18 | 0–18 |
| Income group | 0–300% of FPLa | 0–400% of FPL | 0–250% of FPL |
| Waiting period (time without private insurance) | 3 months | 6 months | 3 months |
| Benefit limits | |||
| Inpatient | None | None | None |
| Other outpatient | None | None | None |
| Dental | 2 cleanings/year | 2 cleanings/year | 2 cleanings/year |
| Vision | None | $75 limit on frames/$110 limit on elective contact lenses | None |
| Outpatient mental health | 20 visits/year | 20 visits/year | 20 visits/year |
| Prescription drugs | None | None | None |
| Copayments | |||
| Inpatient | None | None | None |
| Preventive services | None | None | None |
| Other outpatient | $5 | None | $5 |
| Dental | None | None | None |
| Vision | $5 | $5 | $5 |
| Outpatient mental health | $5 | $5 | $5 |
| Prescription drugs | $5 | $5 | $5 |
| $250 copay limit/family/year | $250 copay limit/family/year | ||
| Family premiumsb | |||
| 0–150% of FPL | $4/child/month ($12 maximum/family) | $4/child/month | $4/child/month ($12 maximum/family) |
| 151–250% of FPL | $6/child/month ($18 maximum/family) | $6/child/month | $6/child/month ($18 maximum/family) |
| 251–300% of FPL | $6/child/month ($18 maximum/family) | $12/child/month | Not applicable |
| 301–400% of FPL | Not applicable | $20/child/month | Not applicable |
| Remaining premium (excluding family contribution) | $87/member/month | $89/member/month | Not available |
a
FPL means “federal poverty level.”
b
In Santa Clara County, parents may choose to pay premiums each month, pay three months in advance and get the fourth month free, or pay nine months in advance and get the last three months free. In San Mateo County, parents are billed for premiums on a quarterly basis but may pay the first three quarters in advance and receive the fourth quarter free. The premiums for Healthy Families come from the public plans. Premiums for private plans are slightly higher.