Guideline Handbook 2008

2008 Guideline Changes

• Dental Sealants
  The Fund will provide a maximum of $7 per sealant for eligible dependent children up to the age of 15. This benefit is limited to eight (8) teeth per child and is a one time, lifetime benefit per child.
• Gardasil Vaccine (Cervical Cancer Vaccine)
  Benefits for Gardasil vaccines for clients and eligible dependents shall be made on a reimbursement basis after each shot provided that the shots are completed in the prescribed monthly installment. Clients and/or their dependent wife or daughter are to be between the ages of 9 and 26. Request for clients and/or their dependents over the age of 26 must present a letter of medical necessity from their physician. The limit per vaccine is $145, or whatever the current health department fee is, with a limit of $50 for the office visit, or whatever the current health department fee is.
• Prescription Medication
  $5 co-pay on all medication. Clients and their dependents with health insurance will be exempt from these co-pays.
• Prescription Medication for the treatment of Hepatitis C
  The Fund will allow up to a maximum of 90 days of assistance for prescription medication for the treatment of Hepatitis C. Referrals will be made to the Health Department and to the drug manufacturer’s charity programs.
• Preferred Providers
  In the Greater Metro Lexington area the Fund utilizes Bluegrass Farm Workers Health Center. Charges incurred without a referral from Bluegrass Farm Workers Health Center will be subject to a $25 co-pay and labs will be limited to $13 each.

In the Greater Metro Louisville area the Fund utilizes the Kentucky Racing Health Service Center. Charges incurred without a referral from Kentucky Racing Health Service Center will be subject to a $25 co-pay and lab’s will be limited to $13 each.

Charges incurred at an out-of-network hospital will not be paid at 100%. (Please see the Hand Booklet for a list of net-work providers or contact the Fund)