208.640. Co-payments required, when, amount, limitations.
Co-payments required, when, amount, limitations.
208.640. 1. Parents and guardians of uninsured children with incomesof more than one hundred fifty but less than three hundred percent of thefederal poverty level who do not have access to affordableemployer-sponsored health care insurance or other affordable health carecoverage may obtain coverage for their children under this section. Healthinsurance plans that do not cover an eligible child's preexisting conditionshall not be considered affordable employer-sponsored health care insuranceor other affordable health care coverage. For the purposes of sections208.631 to 208.659, "affordable employer-sponsored health care insurance orother affordable health care coverage" refers to health insurance requiringa monthly premium of:
(1) Three percent of one hundred fifty percent of the federal povertylevel for a family of three for families with a gross income of more thanone hundred fifty and up to one hundred eighty-five percent of the federalpoverty level for a family of three;
(2) Four percent of one hundred eighty-five percent of the federalpoverty level for a family of three for a family with a gross income ofmore than one hundred eighty-five and up to two hundred twenty-five percentof the federal poverty level;
(3) Five percent of two hundred twenty-five percent of the federalpoverty level for a family of three for a family with a gross income ofmore than two hundred twenty-five but less than three hundred percent ofthe federal poverty level.
The parents and guardians of eligible uninsured children pursuant to thissection are responsible for a monthly premium as required by annual stateappropriation; provided that the total aggregate cost sharing for a familycovered by these sections shall not exceed five percent of such family'sincome for the years involved. No co-payments or other cost sharing ispermitted with respect to benefits for well-baby and well-child careincluding age-appropriate immunizations. Cost-sharing provisions for theirchildren under sections 208.631 to 208.659 shall not exceed the limitsestablished by 42 U.S.C. Section 1397cc(e). If a child has exceeded theannual coverage limits for all health care services, the child is notconsidered insured and does not have access to affordable health insurancewithin the meaning of this section.
2. The department of social services shall study the expansion of apresumptive eligibility process for children for medical assistancebenefits.
(L. 1998 S.B. 632 § 208.185 subsecs. 5, 6, A.L. 2005 S.B. 539, A.L. 2007 S.B. 577)