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Coverage Information

AFFORDABLE HEALTH INSURANCE FOR YOUR CHILDREN

No child should go without the medical or dental care he or she needs. The Children's Medical Security Plan is a program offered by MassHealth that provides the basic medical and dental coverage that kids need most. If you would like to know how to enroll in the Children's Medical Security Plan, please call MassHealth Customer Service at 1-800-841-2900.

CMSP is for children under the age of 19 who are Massachusetts residents at any income level, who do not qualify for any other MassHealth coverage type (except MassHealth Limited), and who do not have physician and hospital health-care coverage. The amounts you pay for coverage depend upon your total family size and income and may even be free.

Some children with CMSP are also eligible for MassHealth Limited, which covers emergency and inpatient services. For a detailed list of the services covered, please contact MassHealth Customer Service at 1 800 841-2900.

Some children may also be eligible for Health Safety Net services provided at acute-care hospitals and community health centers. For information on the Health Safety Net, you can call the HSN Helpline at 877-910-2100 or go to their Web site.

CMSP covers the following medically necessary medical, behavioral-health, dental, and pharmacy services, and only two outpatient surgical procedures:

Medical and Behavioral Health Services

  • Copayments are $2, $5, or $8, depending on household income (see FPL chart), for non-preventive medical visits and all mental health visits; one copayment per day
  • Outpatient office visits including preventive health care visits
  • Radiology
  • Laboratory Services (please visit Quest Diagnostics or another CMSP participating provider)
  • Durable medical equipment up to $200 maximum per state fiscal year (July 1-June 30), with an additional $300 per fiscal year for equipment and supplies related to asthma, diabetes, and seizure disorders only
  • Mental health services and substance abuse treatment up to 20 visits per state fiscal year
  • Surgical procedures, which are limited to insertion and removal of tympanostomy (ear) tubes, including anesthesia (outpatient only) and repair of inguinal hernia, including anesthesia (outpatient only)

Dental

  • Maximum dental benefit is $750 per state fiscal year (July 1-June 30)
  • Copayments are $2, $4, or $6, depending on household income (see FPL chart), for all covered dental care, one copayment per day
  • Dental exams and cleanings (limited to twice per fiscal year)
  • Xrays (Full-mouth series limited to 14 films once every 36 months; bitewing films limited to once per fiscal year)
  • Fluoride treatment (limited to twice per fiscal year)
  • Sealants (limited to once per fiscal year)
  • Fillings
  • Simple extractions
  • Full or partial root canals
  • Crowns on primary teeth
  • Space maintainers used in place of prematurely lost teeth

Pharmacy

  • Prescription drugs up to $200 per state fiscal year (July 1-June 30)
  • Copayments are $3 for each generic drug and $4 for each brand-name drug
  • Prescriptions are administered through Wellpoint Pharmacy ProServ.

Surgical Procedures

The Children's Medical Security Plan covers only two outpatient surgical procedures, as described below.

  • Insertion and removal of tympanostomy tubes (ear tubes), including anesthesia. Prior approval is not required for this procedure.
  • Inguinal hernia repair, including anesthesia. Prior approval is not required for this procedure.

CMSP offers a limited set of benefits and does not cover many services, such as, inpatient hospital care. Please call CMSP Customer Service to find out which specific services are covered.

To make sure that you do not pay for services, use a CMSP participating provider. If you have questions about covered services or a surgical procedure, or to find a participating provider, please call CMSP Customer Service at 1-800-909-2677.

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