Program Benefits and Cost

What are the benefits?

PeachCare for Kids® health benefits include:

  • Care from a doctor when your child is sick
  • Preventive services such as immunizations and regular check-ups
  • Specialist care
  • Dental care
  • Vision care, including vision screenings and eyeglasses
  • Hospitalization
  • Emergency room services
  • Prescription medications
  • Mental health care

Each child will have a choice of a Georgia Families Care Management Organization (CMO), a private health plan that is responsible for coordinating your child’s health care. You will also be able to choose your child’s primary care provider.

Institutionalization:

A child must not be an inmate of a public institution or a patient in an institution for mental diseases at the time of initial application or any redetermination of eligibility.

 

How much does it 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.

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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. 

You may see the full text of the letter explaining co-payments to parents hereThis letter has the co-payment schedule on the second page. 

If you have any questions, please call toll-free at 877-GA-PEACH (427-3224).

 

What happens if I don't pay my premium?

If your premium is late or not paid, your coverage will continue for up to two months before cancellation. If you do not wish the coverage to continue, you must call and request to opt out of coverage by the 15th of the month in which the premium was due. 

For example, the premium payment for coverage in August is due July 1st. If the payment is not received on time, and you do not call to opt out of coverage by July 15th, you will still receive August coverage. You will also be responsible for paying the unpaid premium. 

If the premium payment is not received again August 1st, and you do not call to opt out of coverage by August 15th for September coverage, you will still receive September coverage. You will also be responsible for paying the unpaid premium. 

If the premium payment is not received by September 1st for October coverage, you have until the 15th of September to make your payment. If payment is not received by the 15th of September, coverage will be cancelled effective October 1st and your child will not be eligible for reinstatement until November unless you request coverage for October. If you request coverage for October, you must make a payment to reinstate coverage.