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.
Terms and Definitions
Out of Pocket Limit
- 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.
- 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.