Healthy kids are Iowa's future.

Healthy kids are happy kids. They do well in school, have fun with their friends, and they grow up well. healthy and well kids in iowa (hawk-i) is a program that gives our kids that chance by making sure they have health care coverage. Thousands of Iowa's children qualify for this coverage.

Does hawk-i provides insurance for the whole family?

No. hawk-i provides health care coverage for children and teens, ages 0 to 19.

What does the insurance cover?

The benefits are listed at the end of this page. Pre-existing conditions are covered.

Do I have to fill out a lot of papers?

No. The hawk-i application is short and easy to fill out. There are no health questions. You will need to send in proof of your income with your application.

How do I know if my kids are eligible?

20% of earned income before taxes (including self-employment income) is not counted when comparing family income to the limits. The 20% deduction does not apply to unearned income such as child support, social security disability, or unemployment insurance benefits.

After subtracting 20% of earned income (see example) look up your family's yearly countable income in the yellow chart. If your yearly countable income is the same or less than the amount listed in the far right column, you children could qualify for hawk-i.

EXAMPLE

Family members are Mom and 2 children. Mom works in a florist's shop and earns $24,000 yearly. Additionally she receives $200 per month in child support payments. When determining eligibility for the hawk-i program, income is counted as follows:

Since $21,600 is less than the limit for a 3-member family ($30,040), the children are eligible for hawk-i if all other eligibility factors are met.

What does it cost?

Look at the charts again. If your family's yearly countable income is in the blue chart, then hawk-i is free. If your yearly countable income is in the yellow chart, there is a $10 per month premium per child, but, no matter how large your family, the most a hawk-i premium will cost any family is $20 per month.

NOTE: There is no cost sharing for Native American children when verification of tribal affiliation or other proof verifying Indian blood is provided.

The charts below replace the charts in the brochure. Use these charts to see if your children can get hawk-i.

*Family size includes parents, spouses, stepparents and children under 19 living in the home.

What if I have more questions?

Contact Rhonda Boltz, hawk-i Coordinator for Lee County at 1-800-458-6672, or you may call hawk-i at 1-800-257-8563 (TDD: 1-888-422-2319) anytime, day or night, or log-on to the hawk-i website at www.hawk-i.org.

The hawk-i program covers the following services:

• Doctor Visits
• Outpatient hospital services
• Inpatient hospital services
• Prescription medicines
• Well-child visits
• Vaccines/shots
• Eyeglasses and exams
• Dental care
• Hospice services
• Speech therapy
• Physical therapy
• Ambulance services
• Nursing care services
• Durable medical equipment
• Hearing services
• Home health care
• Chiropractic care
• Mental health/substance abuse care

To qualify for health care coverage with hawk-i the children in your family must:

Eligibility will not be affected by race, color, national origin, age, disability or sex except where it is required by law.

You'll need to provide proof of your income.

• Income from work: Send in pay stubs for the past 30 days or provide a statement from your employer verifying how much you earn.
• Self-employment: Send in your business records or your income tax statement from last year if your income is the same.
• Unearned income: If you have unearned income, like social security disability, child support, unemployment benefits, etc., send in a copy of the award letter, or other proof, telling us how much your benefits are.

NOTE: Eligiblility for the hawk-i program is based on your yearly income. We will average your last 30 days' countable income, if this is the income you expect to earn for the next 12 months, to establish an average monthly amount:
Average Monthly Income X 12 months = Average Yearly Income

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For more information or to get an application contact:

Rhonda Boltz, hawk-i Coordinator
Lee County Health Department
2218 Avenue H
Fort Madison, IA 52627
Phone 1-800-458-6672 or 1-319-372-5225

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Community Health

| hawk-i | HOPES Healthy Families Iowa of Lee County |
| Maternal Child Health | Senior Health | Substance Abuse Prevention |
| Child Immunization Clinics | Lead Poisoning Prevention and Screening |
| Adult Influenza | Tetanus/Diphtheria | TB Screening and follow-up |
| HIV/Aids Testing | Communicable Disease follow-up |

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Copyright 2001 Lee County Health Department Lee County, IA