MinnesotaCare Enrollees. The HEALTH PLAN shall provide, or arrange to have provided to MinnesotaCare Enrollees the same services described in Section 6.1. above with the following modifications. Co-pays apply to some covered services as specified in section 4.3.
A. Inpatient hospital service billings covered up to a $10,000 per calendar year benefit limit.
1.) Parents (including Legal Guardians) whose income is less than or equal to 175% of Federal Poverty Guidelines (FPG), shall not be subject to a limit on Inpatient Hospital services.
2.) For Enrollees who change health plans during the calendar year, charges submitted toward the $10,000 inpatient limit and out of pocket expenses incurred toward the inpatient limit, that were submitted or incurred prior to the change in health plans are disregarded.
B. Dental services covered for preventive services only.
C. Non-pregnant Adults (including Legal Guardians) whose income is less than or equal to 175% of FPG shall receive restorative dental benefits (not including orthodontia) .
D. Outpatient mental health services covered are limited to diagnostic assessments, psychological testing, explanation of findings, medication management by a physician, day treatment, partial hospitalization, and individual, family, and group psychotherapy.
E. Home Care Services are covered, with the exception of private duty nursing and personal care attendant services.
F. Non-emergency medical transportation is not covered.
MinnesotaCare Enrollees. MinnesotaCare Enrollees must make copayments for the following services:
(A) Prescription drugs: Three dollars ($3.00) per prescription.
(B) Eyeglasses: Twenty-five dollars ($25.00) per pair.
