Finding your way through health insurance plans can often seem overwhelming. Many families have access to health insurance as a part of the benefit package their employer offers, while others purchase health insurance on their own. Many of the ‘mandates’ for coverage issued by the state legislature will not always apply equally to group and individual policies. As families seek to ensure their coverage needs are met, it is important to learn about the type of insurance plan held, its limits and the policy owner’s related rights. Call your insurance company to determine is ABA is a covered benefit.
Indiana Children’s Special Health Care Services (CSHCS)
CSHCS provides supplemental medical coverage to help families of children who have serious, chronic medical conditions, age birth to 21 years of age, who meet the program’s financial and medical criteria, pay for treatment related to their child’s condition. A family with an income, before taxes, no greater than 250% of the federal poverty level may be eligible for the program. The financial level changes every year. For example, in 2014, a family of four could qualify with a gross income of up to $59,625. You can visit their website to determine eligibility at: http://www.in.gov/isdh/23685.htm
Affordable Healthcare Act (ACA)
In general, the ACA is designed to improve the quality and lower the costs associated with health care; provide consumer protections, mainly in regard to insurance coverage; and increase access to care. All individuals are guaranteed coverage regardless of pre-existing conditions. Individuals cannot be charged higher premiums because of a pre-existing condition.
Essential Health Benefits (EHB)
The EHB define the categories of care that must be covered by insurance plans. The 10 benefit categories are:
- ambulating patient services
- emergency services
- maternity & newborn care
- mental health & substance use disorder services
- prescription drugs
- rehabilitation and habilitative services and devices
- laboratory services
- preventative and wellness services and chronic disease management
- pediatric services, including oral and vision care
Marketplaces have been created for the purchase of health insurance. Individuals and families may access the marketplace to compare insurance policies and make a purchase decision. Indiana is utilizing the federal marketplace. Consumers may decide on differing levels of coverage with varying levels of premium cost, co-pays, and co-insurance.
United Healthcare Children’s Foundation:
a not for profit that provides grants to cover out-of-pocket medical expenses for children 16 years old or younger that are not covered or not completely covered by a family’s private health insurance. Additional information and an online application can be found at www.uhccf.org.