Note: This is the benefits package for HUSKY Part B. It provides
health insurance to children who are not eligible for HUSKY Part A (existing full Medicaid
program). The benefits package for HUSKY Part A is similar, except that there are no
co-payments or premiums. Both HUSKY Part B and HUSKY Part A are now known under the
umbrella name of HUSKY--to support the enrollment of children of all income
levels into a health insurance program.
|
| Benefit Features |
Husky Coverage |
|
|
| Deductible |
None |
| Coinsurance |
None |
| Lifetime Benefit Maximum |
None |
| Outpatient Physician Visits |
$5 co-pay |
| Preventive Care |
|
| Periodic and well child visits,
immunizations, WIC evaluations, and prenatal care covered in full with $5 co-pay on other
visits. Periodicity schedule and reporting based on the American Academy of Pediatrics
(see below). |
|
- Age category
Birth to age 1
Ages 1-5
Ages 6-10
Ages 11-19th birthday
|
- No. Exams
6 exams
6 exams
1 exam every 2 years
1 exam every year
|
| Inpatient Physician |
100% |
| Inpatient Hospital |
100% |
| Outpatient Surgical Facility |
100% |
| Ambulance |
100% if determined to be an emergency in
accordance with state law |
| Pre-Admission / Continued Stay |
Arranged through provider |
| Prescription Drug |
$3 co-pay on generics
$6 co-pay on brand names.
Formularies |
| Mental Health |
|
| Inpatient |
100% except for the following conditions
additional limitations apply:
Mental retardation;
Learning, motor skills,
communication and caffeine-related disorders;
Relational problems;
Other conditions that may be the focus of clinical attention that are not defined as
mental disorders in the American Psychiatric Associations "Diagnostic &
Statistical Manual of Mental Disorders." These limitations are:
60 day maximum exchangeable with alternative levels of care.
Supplemental coverage available under the Connecticut Behavioral Health
Partnership toll free at 1-877-552-8247; TTY/TDD 1-866-218-0525. They also
have a website at
www.ctbhp.com . |
| Outpatient |
$5 copay except for the following conditions:
Mental retardation;
Learning, motor skills,
communication and caffeine-related disorders;
Relational problems;
Other conditions that may be the focus of clinical attention that are not defined as
mental disorders in the American Psychiatric Associations "Diagnostic &
Statistical Manual of Mental Disorders." For these above stated conditions, the
following apply:
30 visits
1-10: 100%
11-20: $25 co-pay
21-30: Lesser of a $50 co-pay or 50%. Supplemental
coverage available under HUSKY Plus for medically eligible
children. |
| Substance Abuse |
|
| Detoxification |
100% |
| Inpatient |
100% except for the following conditions
additional limitations apply:
Mental retardation;
Learning, motor skills,
communication and caffeine-related disorders;
Relational problems;
Other conditions that may be the focus of clinical attention that are not defined as
mental disorders in the American Psychiatric Associations "Diagnostic &
Statistical Manual of Mental Disorders." These limitations are:
Drug: 60 days
Alcohol: 45 days
|
| Outpatient |
100% except for the following conditions
additional limitations apply:
Mental retardation;
Learning, motor skills,
communication and caffeine-related disorders;
Relational problems;
Other conditions that may be the focus of clinical attention that are not defined as
mental disorders in the American Psychiatric Associations "Diagnostic &
Statistical Manual of Mental Disorders." These limitations are:
60 visits per calendar year.Supplemental coverage
available under HUSKY Plus for medically eligible children. |
| Skilled Nursing |
100% with prior authorization. |
| Home Health |
100% |
| Hospice |
100% |
| Short Term Rehab and Physical Therapy |
100% |
| Long Term Rehab and Physical Therapy |
Supplemental coverage available under HUSKY Plus for medically eligible children. |
| Lab and X-Ray |
100% |
| Pre-Admission Testing |
100% |
| Emergency Care |
$25 co-pay, unless it is determined to be an
emergency in accordance with state law. $25 co-pay also waived if the patient is admitted. |
| Durable Medical Equipment |
100% with prior authorization.
Supplemental coverage available under HUSKY Plus for medically eligible children. |
| Prosthetics |
100% with prior authorization. Supplemental coverage available under HUSKY
Plus for medically eligible children. |
| Eye Care |
$5 co-pay on exams. Optical hardware
partially covered: Lenses and up to $50 for frames,
once every two years. Maximum of $100 for lenses and frames per prescription. |
| Hearing Exam |
$5 co-pay |
| Nurse Midwives |
$5 co-pay |
| Nurse Practitioners |
$5 co-pay |
| Podiatrists |
$5 co-pay |
| Chiropractors |
$5 co-pay |
| Naturopaths |
$5 co-pay |
| Hearing Aids |
Covered under HUSKY Plus
for medically eligible children |
| Therapies (OT, Speech) |
Short term coverage with prior authorization. Supplemental coverage available under HUSKY
Plus for medically eligible children. |
Dental
- Supplemental coverage available under HUSKY
Plus for medically eligible children.
|
|
| Exams, 1 every 6 months |
100% |
| X-Rays |
100% |
| Fillings |
100% |
| Fluoride Treatments |
100% |
| Oral Surgery |
100% |
| Sealants |
100% |
| Bridge and Crown |
Co-Pay |
| Root Canals |
Co-Pay |
| Dentures (full and partial) |
Co-Pay |
| Extractions |
Co-Pay |
| Orthodontia |
Covered up to allowance |
| Family Planning |
|
| Oral Contraceptives |
$5 co-pay included in prescription drugs |
| Family Planning Services |
Covered in full |
| Co-payment and premium maximums |
|
| Families with household incomes between 185%
and 235% of federal poverty level. For example, a family of four with an annual
income from $35,798 to $45,473. |
$650 co-payment maximum per year. No
premiums charged |
| Families with household incomes between 235%
and 300% of federal poverty level. For example, a family of four with an annual income
from $45,474 to $58,050. |
$1,250 combination maximum of co-payments and
premiums per family, per year |
| Families with household incomes above 300% of
the federal poverty level. For example, a family of four with an annual income over
$58,050. |
No maximums on co-payments or premiums
(families buy into the plan at the negotiated group rate) |
|
For more information on HUSKY
call:
1-877-CT-HUSKY
(1-877-284-8759 -- Toll Free)
Individuals who are deaf or hearing impaired can call our TTD/TTY telephone number at:
1-800-842-4524 |
