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Frequently
asked questions
What
is the difference between Kaiser Permanente Child
Health Plan and the Healthy Families Program?
Which
services are not covered by Child Health Plan?
Is
a medical review required as part of the Child Health Plan application?
Is
my child's Social Security number required on the Child Health Plan
application?
Will
I need to recertify my child for Child Health Plan?
What
are the copayment limits for Child Health Plan, and what should
I do when my copayment limit has been reached?
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 Child Health Plan?
Once
my child is enrolled under Child Health Plan, can I use any doctors
who are not with Kaiser Permanente?
What is the purpose of the Contract Dentist Selection Form?
What will happen if the Contract Dentist Selection Form is not submitted?
When filling out the enrollment forms, should the completed Contract Dentist Selection Form be sent in with the application?
Is
there an application fee for Child Health Plan?
Who
can I call if I still have questions?
What
is the difference between Kaiser Permanente 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).
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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:
- chiropractic
services
- contact
lens examinations, fitting, and dispensing
- refractive
eye surgery
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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.
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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.
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Will
I need to recertify my child for Child Health Plan?
Yes, recertification is necessary every year for continued
Child Health Plan membership. Children accepted for enrollment are
eligible for membership in Child Health Plan for a period of 12
months. A few months before the 12th 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.
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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, $500 for
two children or more. When you pay a copayment, always ask for a
receipt. When the copayment limit has been reached, bring the receipts
to the business office at your local Kaiser Permanente medical center.
You will be given a card to show that no more copayments are due
for the remainder of the calendar year.
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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 Child Health Plan?
Yes.
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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.
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What
is the purpose of the Contract Dentist Selection Form?
The Contract Dentist Selection Form allows the enrollee to choose
his or her preferred dentist (usually based on proximity, availability,
and language preference). We highly encourage all applicants to
fill out the Contract Dentist Selection Form because they will more
than likely be assigned to the dentist of their choice. Also, in
the case where there are multiple children from the same family
enrolled in the Child Health Plan, the Contract Dentist Selection
Form will ensure that all children in the family will have the same
dentist.
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What
will happen if the Contract Dentist Selection Form is not submitted?
If we do not receive the Contract Dentist Selection Form, a dentist
is automatically assigned to the child by PMI Delta Dental's computer
based upon the child's ZIP code. It is possible that children from
the same family may end up with different dentists at different
locations. Also, the dentist selected may not speak the family's
preferred language.
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When
filling out the enrollment forms, should the completed Contract
Dentist Selection Form be sent in with the application?
Yes. In addition to sending in the Kaiser Permanente Child Health
Plan application, we encourage the applicant to also send in the
completed Contract Dentist Selection Form to Community Benefits.
If the dentist selection is made at a later date or if a change
to a preassigned dentist is needed, the enrollee can call PMI Customer
Service at 1-800-422-4234 to inform them of the change.
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Is
there an application fee for Child Health Plan?
There is no application fee.
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Who
can I call if I still have questions?
If you have additional questions, call us at 1-800-464-4000 (toll
free).
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