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Classic
Blue®
For the
Healthy and Well Kids in Iowa (hawk-i) Program
The Classic Blue coverage is available to
children who qualify for coverage through the State of Iowa’s hawk-i
program. To
determine if you qualify, please call 1-800-257-8563 or visit the hawk-i program Web site at www.hawk-i.org.
| Classic Blue
Coverage |
| Benefit Period
Deductible |
None |
| Coinsurance |
None |
| Out-of-Pocket Maximum |
None |
| Lifetime Benefit
Maximum |
$1,000,000 |
| Type of Plan |
Managed Indemnity |
| Prescription Drugs |
You pay nothing for
generic drugs, or for brand name drugs when no generic is available |
| Dental Care |
Covered |
| Hearing |
Covered |
| Vision |
Covered |
| Preventive Care |
Covered |
| Well Child Care |
Covered |
| Chiropractic Care |
Covered |
| Mental Health and
Chemical Dependency |
Covered (annual limit
of 30 inpatient days and 30 outpatient visits) |
| Emergency Care |
Covered anywhere in the
world; $25 copay if the visit is not a medical emergency and you pay for your hawk-i coverage |
| Out of Area Coverage |
Covered through the
BlueCard® program |
| Notification
Requirements |
You are responsible for
notification requirements |
View a list of covered drugs.
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