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Peachcare for Kids

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PeachCare for Kids is a public health insurance program that offers high quality, comprehensive health coverage for children 0-19 years of age. It covers medical, dental and vision services.*

Eligibility

Eligible children must be a resident of Georgia, a US citizen or children of qualified immigrants who have refugee status or whose parents have been permanent residents for a minimum of 5 years. Children and teens

PeachCare for Kids was created to provide health care to uninsured children. For this reason, children must be uninsured for the two months prior to applying for PeachCare for Kids. There are exceptions to the waiting period for children who have lost coverage involuntarily or experience a life changing event, which are listed below:

  • Change in employment resulting in a child’s loss of employer-sponsored insurance (including leave of absence without pay or reduction in work hours).
  • When the child’s eligibility and enrollment in Medicaid or another insurance affordability program is terminated.
  • The employer stopped offering coverage of dependents (or any coverage) under an employer-sponsored health insurance plan.
  • The loss of health insurance coverage as a result of the death of a parent.
  • The cost of coverage for the child or family coverage that includes the child exceeded 5 percent.
  • The child has special health care needs.
  • The child lost coverage due to the divorce of a parent.
  • The child’s parent is determined eligible for advance payment of the premium tax credit for enrollment in a QHP through the Marketplace because the ESI in which the family was enrolled is determined unaffordable in accordance with 26 CFR 1.36B-2( c) (3)(v).
  • Cancellation of COBRA or an individual insurance policy.
  • The child was born during the two month waiting period.
  • Parent on leave of absence without pay, or reduction of work hours.
  • Employer cancellation of entire group plan.

What is needed to apply

  • Birth certificate (Georgia-born residents do not have to have a copy to apply)
    • The Social Apostolate of Savannah may be able to help obtain out-of-state birth certificates for people who are in financial hardship. They are located at 502 East Liberty Street, Savannah, (912) 233-1877
  • Form of Government-issued Photo ID: e.g. Driver’s License, Passport (US or foreign) State issued identification card, Consular Identification Card

  • Social Security number for each child or proof that a card has been applied for.
  • Income documents (for one month- i.e. one month’s worth of paystubs or Form 809 for cash-only income from one employer or Form 126 – 3 months for cash-only self-employed income

Non-US Citizens

Non-U.S. citizens who apply for Medicaid or PeachCare for Kids for their U.S.-born children do not have to prove citizenship, legal residency status or present a social security number. Applying for services does not trigger any action with USCIS Immigration Service.

Cost

There is no cost for children under age 6. Currently, the cost per month for PeachCare for Kids® coverage is $0 to $36 for one child and a maximum of $72 for two or more children living in the same household. Once you complete the application, information about paying your premium will be displayed.

You will have a co-payment for some medical services in the PeachCare for Kids program, if your child is 6 years of age and older.

A co-payment is a small fee you will have to pay at the time of your visit to a medical provider. The amount of the co-payment will be different depending on the medical services you receive. While these co-payment amounts can range from $0.50 to $12.50, most will be $2 or $3. If you have to make a co-payment, your medical provider will tell you at the time of your visit.

However, there are no co-payments for these services:

  • Emergency services
  • Preventive Care Services (routine check-ups for your child)
  • Immunizations
  • Routine preventive and diagnostic dental services (such as oral examinations, prophylaxis and topical fluoride applications, sealants, and X-rays).

You are not required to pay more than 5% of your yearly income for premiums and co-payments. If your family reaches the 5% limit, you will not be required to make co-payment and premium payments for the rest of the year. Because of this, you must tell us (the PeachCare for Kids Program) about any changes to your family income. Also, co-payments are not required for children in foster care or children who are American Indians or Alaska Natives.  No deductible is required.

After the child is enrolled, the parents will receive an informational packet from Georgia Families. Parents will have a choice of three Care Management Organizations (CMOs): Peach State Health Plan, Amerigroup and WellCare of Georgia. If no choice is made, the child will automatically be enrolled in Amerigroup. Parents need to check to see what CMO is accepted at a preferred doctor’s office.

How Long Does It Take to Enroll?

It takes approximately 45 days for the enrollment process.

*Source: www.peachcare.org. Retrieved August 4, 2016.