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Costs for an individual not participating in the State Coverage Insurance (SCI)
program through an employer include:
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Monthly Premiums based on Federal Income Guidelines
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- 0-100% FPL = $0 monthly premium
- 101%-150% FPL= $95 monthly premium
- 151%-200% FPL= $110 monthly premium
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Co-Payments are also based on the Federal Income Guidelines scale above.
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- 0-100% FPL= $0 co-payments
- 101-150% FPL=Mostly $5 co-payments, Inpatient services are $25, Emergency Care is
$15
- 151%-200% FPL=Mostly $7 co-payments, Inpatient services are $30, Emergency Care
is $20
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Prescriptions are $3 per prescription. The maximum you will pay out of pocket is
$12 per month. This means that after you’ve paid $12 in any given month, prescriptions
will be $0 for the remainder of the month.
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