Wyoming Administrative Code
Agency 048 - Health, Department of
Sub-Agency 0064 - Kid Care CHIP
Chapter 4 - COST SHARING
Section 4-3 - Cost Sharing Maximums and Tracking Requirements

(a) Cost sharing shall not exceed five percent (5%) of a family's gross income for the length of the child's eligibility period as specified in 42 C.F.R. § 457.560.

(b) Each family shall be notified of their cost sharing maximum for the eligibility period. Families shall track their cost sharing expenditures and submit receipts to the Department when they believe they have met their total cost sharing maximum for the eligibility period.

(c) Families will track their benefit year cost sharing expenditures for medical, pharmacy, dental and medically necessary orthodontia and submit receipts to the Department when they believe they have met the benefit year cost sharing maximum for medical and/or pharmacy and/or dental and/or medically necessary orthodontia.

(d) The benefit year cost sharing maximums and co-payments for particular medical, pharmacy and dental services shall be determined by the Department and insurance contractor. The benefit year cost sharing maximums and co-payments may be adjusted at the establishment of a new contract or contract extension with the insurance contractor.

(e) If it is determined the family has paid more than their five percent (5%) annual cost sharing maximum or medical, dental, pharmacy or medically necessary orthodontia co-payment maximum(s) the family shall be reimbursed by the insurance contractor.