It may not surprise you, but many people struggle to understand their health coverage plans. Below is a quick overview of some of the health coverage terms you may come across when reviewing your child’s Kid Care CHIP plan. Remember for questions about specific Kid Care CHIP coverage please call Blue Cross Blue Shield of Wyoming at 1-800-209-9720 or Delta Dental of Wyoming at 1-800-735-3379.
Terms and Definitions
This is a fixed amount you pay for a covered health care service. You usually pay this at the time of service and co-pays may vary with the type of health care service. For details on Kid Care CHIP co-payments please see the Kid Care CHIP handbook.
Co-insurance is your share of the costs of a covered health services. In most plans, you pay co-insurance plus deductibles. You may pay 20% co-insurance of the cost for a service and your plan may pay 80%. With Kid Care CHIP you are not responsible for co-insurance.
The share of costs covered by your insurance that you pay out of your own pocket. This term generally includes deductibles, co-insurance, and co-payments, or similar charges, but it doesn’t include premiums, balance billing amounts for non-network providers, or the cost of non-covered services. Cost sharing in Medicaid and CHIP also includes premiums.
The amount you need to pay for your health care before your insurance or plan will pay. With Kid Care CHIP there is no deductible.
When a patient stays overnight in a health care facility for care, that is considered inpatient care. When a patient receives care with no overnight stay, this is called considered outpatient care. You must have prior authorization from Blue Cross Blue Shield of Wyoming before your child has an inpatient stay at a health care facility. In this event, please contact Blue Cross Blue Shield of Wyoming at 800-209-2720.
Out of Pocket Limit
The most you will pay during a policy period (January 1 to December 31 for Kid Care CHIP) before your health insurance pays 100% for covered health benefits. With Kid Care CHIP you will never have to pay more than 5% of your income.
- Medical Out of Pocket Maximum per Benefit Year up to $300 per child
- Pharmacy Out of Pocket Maximum per Benefit Year up to $200 per child
- Dental Out of Pocket Maximum per Benefit Year up to $75 per child
Prior authorization: A decision by your health insurer that a health care service is medically necessary. Your healthcare plan may require prior authorization for certain services.
- For dental care, prior authorization is recommended for services over $250.
A provider who has a contract with your insurance plan to provide services to you at a discount. Treatment from a provider who is outside the Kid Care CHIP PPO network will require prior authorization from Blue Cross Blue Shield of Wyoming.
- If you receive care from a provider who is not in the PPO and do not receive prior authorization you will be responsible to pay for services. Please call Blue Cross Blue Shield of Wyoming at 800-209-2720 if you have questions about your provider.
- For dental care through Delta Dental of Wyoming, there are no exceptions, you must always see a Kid Care CHIP participating dentist.
Preferred Provider Organization (PPO)
Kid Care CHIP is a PPO. Providers are a network of doctors, hospitals, and other health care providers who have agreed to participate in caring for your child with Blue Cross Blue Shield of Wyoming.
For more health coverage terms download a great resource from the US Government: Glossary of Health Coverage and Medical Terms.