Kentucky Spirit Health > For Members > Benefit Information > Family Choices

Family Choices

Text Sizer: A A A

Most children are exempt from co-pays. Those subject to co-pays are children with household income greater than 133% of federal poverty level.

Service Benefits Limitation Co-pays
Acute Inpatient Hospital Services $0
Allergy Services Shots and allergy treatments limited to children under 21 $2 co-pay for office visit and testing
Audiometric Services One audiologist visit per calendar year $0
Behavioral Health Services $0
Chiropractic Services Limited to 26 visits per 12-month period for children and adults $0
Dental Services Children under 21, to include:
2 cleanings per 12-month period
Extractions and fillings
1 set of x-rays per 12-month period
Other dental services are available		 $0
Durable Medical Equipment (DME) $0
Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Limited to children under 21. KCHIP III children are not eligible for EPSDT Special Services and non-emergency transportation. $0
Emergency Ambulance $0
Emergency Room See Emergency Room section of this handbook 5% co-insurance for non-emergency visits not to exceed $6 per visit
End Stage Renal Disease and Transplants $0
Family Planning $0
Hearing Aids Limited to children under 21
Not to exceed $800 per ear every 36 months		 $0
Home Health Services Limited to 25 visits per calendar year $0
Hospice (non-institutional) $0
Laboratory, Diagnostic and Radiology Services $0
Maternity Services

  • Nurse mid-wife services
  • Pregnancy-related services
  • Services for other conditions that might complicate pregnancy
  • 60 days postpartum pregnancy-related services
 $0
Occupational Therapy At an approved setting $0
Out-patient Hospital / Ambulatory Surgical Centers $0
Physical Therapy At an approved setting $0
Physician Office Services $0
Podiatry Services $0
Prescription Drugs
  • For adults 21 and over, limited to 4 prescriptions per month with a maximum of 3 brand names
  • These limits do not apply to children under 19.
  • Insulin is excluded from the 4-prescription limit
  • Ask your doctor or pharmacist about exceptions for medical conditions or certain drugs
  • $1 generic
  • $2 preferred
  • $3 non-preferred brand
Preventive Services $0
Prosthetic Devices $1500 maximum per calendar year $0
Speech Therapy At an approved setting $0
Substance Abuse EPSDT and pregnant women only. $0
Tobacco Cessation Assessment
  • No co-pay for the actual assessment;
  • $2 co-pay for the office visit;
  • No co-pay for the smoking cessation drugs;
  • All drugs, if prescribed are covered and DO NOT require a prior authorization for the initial fill;
  • Refills of the prescribed smoking cessation drugs require approval from Kentucky Spirit Health Plan.
Vision Services
  • Eyewear limited to children under 21
  • $400 limit per calendar year Maximum paid for one pair of glasses is $150
  • Children limited to 1 eye exam per calendar year
 $0