FamilyCare Cost Sharing

Services	FamilyCare Assist	FamilyCare Share	FamilyCare Premium
Monthly premiums	$0	$0	Premium Level 1 $15 for one person, $25 for two people, $30 for three people, $35 for four people, $40 for five or more people. Premium Level 2 $80 per adult Premium Level 3 $140 per adult
Medical visits	$2 per visit	$2 per visit	$2 per visit
Prescriptions	$0 for generics $3 for brand drug	$0 for generics $3 for brand drug	$0 for generics $3 for brand drug
Emergency room use in non-emergencies	$0	$0 per visit	$0 per visit
Inpatient hospitalization	Up to $3 per day	Up to $3 per day	Up to $3 per day
Maximum family cost per year	N/A	N/A	N/A

*	Families with children who are in All Kids Rebate follow the cost sharing requirements of their employers or private health insurance plans.
*	Families with children who are American Indians or Alaska Natives do not pay premiums or co-payments.

FamilyCare Hotline 1-866-ALL-KIDS (1-866-255-5437)
TTY: 1-877-204-1012

FamilyCare