Helping families afford health coverage
Higher premiums for employee dependents have resulted in nearly nonexistent enrollments, putting a large swath of children uncovered and at risk. FocusHealth for Kids is a Dependent Care Program to close this gap.
Benefit Highlights
- Affordable solution for dependent children from age 1 - 26
- Low copays for doctor visits, Rx and hospitalization
- No annual deductible
- National provider network
- Coverage guaranteed with no underwriting
- No district contribution required
- No minimum enrollment or participation requirements
Below is a breakdown of the benefits for the two plans available.
Low Plan |
High Plan |
|
|---|---|---|
Benefits |
In Network Only  |
In Network Only  |
| Provider Network | PHCS | PHCS |
| Deductible (Does not include Co-pays) | None | None |
| Out of Pocket Maximums | None | $5,000 Individual/$10,000 Family |
Professional Services |
||
| Office Visits - Primary Care (exam or consultation) | $25 Copay, limited to 5 visits | $15 Copay, limited to 10 visits |
| Office Visits - Specialist (exam or consultation) | $50 Copay, limited to 5 visits | $25 Copay, limited to 10 visits |
| Preventive Care | Plan pays 100% | Plan pays 100% |
| Diagnostic Services - Basic labs/x-rays (related to office visit, LabCorp, etc.) | $50 Copay, plan pays 100%, limited to 3 visits | $50 Copay, plan pays 100%, limited to 3 visits |
| Diagnostic Services - Major (MRI, CT, PET, Nuclear Medicine,etc.) *US Imaging Network | $350 Copay, Limited to 1 Visit Per Year | $350 Copay, Limited to 2 Visits Per Year |
| Diagnostic Services - Minor (ultrasounds, bone density, ecography,etc) | $50 Copay, plan pays 100%, limited to 2 visits | $50 Copay, plan pays 100%, limited to 2 visits |
Hospital Services |
||
| Inpatient Hospital Deductible | None | None |
| Inpatient Hospital | $350 Copay per day, limited to 2 days per year | $350 Copay per day, limited to 6 days per year |
| Inpatient Physician | Included in Hospital daily copay. Limited to 2 days | Included in Hospital daily copay. Limited to 6 days |
| Surgery | Included in Hospital daily copay. Limited to 1 day | Included in Hospital daily copay. Limited to 3 day |
| Outpatient Hospital Services | $350 Copay, Plan pays 100%. Limited to 1 visit | $350 Copay, Plan pays 100%. Limited to 2 visits |
Emergency Services |
||
| Emergency Room Facilities | $350 Copay, Plan pays 100%. Limited to 1 visit | $350 Copay, Plan pays 100%. Limited to 1 visit |
| Emergency Room - All covered services other than facility charges | Plan pays 100% | Plan pays 100% |
| Urgent Care Center & 24 Hour Clinic | $50 Copay, Plan pays 100%, limited to 2 visit. | $35 Copay, Plan pays 100%, limited to 3 visit. |
RX Benefits |
||
| Generic Only Less than $9.99, member pays 100%; more than $9.99, 45% coinsurance. Limit of $150 per RX. $800 annual maximum. | 20% Coinsurance. Limit $150 per RX. | |
Other Services |
||
| Telemedicine | Included $0 Copay | Included $0 Copay |
Disclaimer: The two plan options described above are self-funded plans using a Captive arrangement. If there is any inconsistency between this document and the official plan documents and contracts, the official plan documents and contracts will control.