As a State Health Benefit Plan member, you may be eligible to enroll your children in PeachCare for Kids.®
This health insurance program – funded with federal and state tax dollars as well as member premiums and copays -- provides quality health care coverage including vision, dental, check-ups, prescription medicine and more to children ages 0 to 19. health care coverage will end on the last day of the month the child turns 19.
You will have a co-payment for some medical services in the PeachCare for Kids program,if your child is 6 years or older.
A co-payment is a small fee you will have topay at the time of your visit to a medical provider. The amount of the co-payment will be different, depending on the medical services you receive. While the co-payment amounts can range from $.50 to $12.50, most will be $2 or $3. If you have to make a co-payment, your medical provider will tell you at the time of your visit.
With PeachCare for Kids, your premiums may be lower (with no premiums for children under 6) and there are no deductibles. In fact, you may save more than $2,000 per year by enrolling your children in PeachCare for Kids instead of the State Health Benefit Plan. The current monthly premium cost for PeachCare for Kids for one child (age 6 to 19) ranges from $11 to $36 with a maximum of $70 for two or more children (ages 6 to 19) living in the same household.
One of the eligibility criteria for PeachCare for Kids is household income. For example, a family of three earning up to $49,632 annually or a family of four earning up to $59,904 annually may qualify.
How PeachCare for Kids Benefits Working Families
- PeachCare for Kids is high-quality, low-cost major medical health insurance for children ages 0 to 19.
- Coverage includes hospitalization; dental and vision care and mental health services are included at no additional cost to members.
- State and public school employees and retirees can apply for PeachCare for Kids coverage for their children, provided the child(ren) has (have) not been covered under any health insurance plan for at least two months prior to making application.
- PeachCare for Kids significantly reduces your out-of-pocket costs by switching your child’s (children’s) health care benefits from the State Health Benefit Plan to PeachCare for Kids.
- PeachCare for Kids’ monthly premiums are low or zero; there is no premium for children under age 6; and there is a low premium ($36 or less for one child; maximum of $72 or less total for two or more children) for children ages 6 to 19.
- PeachCare for Kids may save an eligible single parent up to $250 or more per month.
- Your child’s physician may already be a PeachCare for Kids provider.
Eligibility Criteria
PeachCare for Kids® is available for children through age 18 in families who meet the following criteria:
| Family Size | 1 | 2 | 3 | 4 |
| Monthly Income Limit | $2,432 | $3,279 | $4,136 | $4,992 |
| Annual Income Limit | $28,706 | $38,348 | $49,632 | $59,904 |
- Income amounts are based on 247 percent of the Federal Poverty Guidelines.
- PeachCare for Kids requires verification of income at application and annual renewal. Eligibility is dependent on the successful completion of this documentation. Go to Income Verification for more information.
- The child or children must have been uninsured for at least two months before being considered for enrollment in PeachCare for Kids.
- To be eligible for PeachCare for Kids, your child(ren) must be a U.S. citizen or fall within an eligible legal immigrant category. Original documents may be required to verify the status of the child(ren) for whom you are applying. Parents are not required to verify their own citizenship or immigration status. For more information, go to: Citizenship Verification
- Please go to to www.PeachCare.org for more information about eligibility.
Affordable Care Act Health Insurance Coverage
You may also qualify for a lower cost health insurance plan through the Health Insurance Marketplace under the Affordable Care Act. To find out if you qualify, visit www.healthcare.gov. Open Enrollment for the Health Insurance Marketplace began November 1, 2015 and will end January 31, 2016.
Maintaining Your Child’s Health Insurance Coverage
If your child loses PeachCare for Kids coverage, you have 60 days from the loss of coverage to enroll your child in SHBP. It is not a qualifying event to enroll your children in SHBP if PeachCare for Kids denies enrollment or if coverage under PeachCare ends because of failure to pay the monthly premiums.
Enrollment in PeachCare for Kids
The PeachCare for Kids enrollment process can take up to 45 days.
Income and Waiting Period
Please note that if your monthly premiums exceed 5 percent of your gross income, there is no waiting period for coverage to begin. However, if your monthly premiums do not exceed 5percent of your gross income, you will be subject to a two-month waiting period.
Visit www.peachcare.org or call 1-877-427-3224 for more information.