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GA PeachCare for Kids - Medical Insurance

PeachCare is an alternative for children who are not eligible for Medicaid. In 1997, Congress created Title XXI of the Social Security Act, The State Children's Health Insurance Program (SCHIP), to provide health care for the growing number of uninsured children in the United States. This legislation provided states with the opportunity to create programs to increase access to affordable health insurance. In Georgia, this program is PeachCare for Kids.

PeachCare for Kids began covering children in 1999, providing comprehensive health care to children through the age of 18 who do not qualify for Medicaid and live in households with incomes at or below 235% of the federal poverty level. This means a family of three can earn over $39,000 a year and a family of four can earn $47,000 a year (in 2006).

Eligibility

Eligibility requirements:

·             U.S. citizens, certain qualified legal residents, refugees or asylees who reside in Georgia

·             Age 18 and under

·             Uninsured

·             Family income less than or equal to 235% of the federal poverty level, over $39,000 for a family of 3 and $47,000 for a family of 4 in 2006.

Citizenship requirements:

·             To be eligible for PeachCare, children must be citizens of the United States or have resided legally in the United States for at least 5 years.

Note: Citizenship applies ONLY to the child. Citizen children of non-citizen parents ARE eligible for PeachCare.

Your child may be ineligible if:

·             Your child is eligible for Medicaid. If your child is eligible for Medicaid, Peachcare for Kids will forward your application to Medicaid and your child will be enrolled.

·             Your child has access to health insurance through a parent's employment with the State of Georgia, even if the parent has not purchased the State coverage.

Covered Services:

PeachCare 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 in the program has a Georgia Better Health Care (GBHC) primary care provider who coordinates the child's care.

Cost

Premiums increase on a sliding scale based on household income.

There is no cost for children under age 5.

Starting at age 6, premiums are $10 to $35 for one child in a family. For two or more children, your premium will be from $20 to $70, depending on your household income.

Monthly premiums will not exceed $70, regardless of the number of children in a family.

There are no co-payments or deductibles required for benefits covered by PeachCare for Kids.

Not for Children of State Employees

Federal regulations prohibit children of state employees from receiving PeachCare for Kids coverage. This includes employees of the public school system and the Board of Regents who have access to state health benefits. The exclusion does not apply to part-time and temporary employees who are not eligible to enroll in the state health benefit plan.

6-Month Uninsured Requirement

PeachCare for Kids was created to provide health care to uninsured children. For this reason, children must be uninsured for the six months prior to applying for PeachCare.

There are exceptions for children who have lost coverage involuntarily (for example, if a child were covered through a parent's employer and the parent lost the job, or the employer dropped coverage for dependent children). The waiting period does not apply to families who had independently purchased private insurance outside of an employer group.

Additional Information

An online application for PeachCare is available at:
https://www.peachcare.org/DE03.asp

If you need additional assistance, call 1-877-GA-PEACH (1-877-427-3224).

Back to:

Medicaid Overview

Medicaid Financial Eligibility

Georgia Benefit Information System (GABIS) Overview

Source

The information about PeachCare is drawn from the PeachCare website at: http://www.peachcare.org/.

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