This text of Indiana § 12-15-44.5-4.7 (Application; pregnant woman exemption; payments; failure to make
payments; state contribution; change in health plan; reimbursement) is published on Counsel Stack Legal Research, covering Indiana primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.
7.
(a)To participate in the plan, an
individual must apply for the plan on a form prescribed by the office.
The office may develop and allow a joint application for a household.
(b)A pregnant woman is not subject to the cost sharing provisions
of the plan. Subsections (c) through (g) do not apply to a pregnant
woman participating in the plan.
(c)An applicant who is approved to participate in the plan does not
begin benefits under the plan until a payment of at least:
(1)one-twelfth (1/12) of the annual income contribution amount;
or
(2)ten dollars ($10);
is made to the individual's health care account established under
section 4.5 of this chapter for the individual's participation in the plan.
To continue to participate in the plan, an individual must contribute to
the individual's he
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7. (a) To participate in the plan, an
individual must apply for the plan on a form prescribed by the office.
The office may develop and allow a joint application for a household.
(b) A pregnant woman is not subject to the cost sharing provisions
of the plan. Subsections (c) through (g) do not apply to a pregnant
woman participating in the plan.
(c) An applicant who is approved to participate in the plan does not
begin benefits under the plan until a payment of at least:
(1) one-twelfth (1/12) of the annual income contribution amount;
or
(2) ten dollars ($10);
is made to the individual's health care account established under
section 4.5 of this chapter for the individual's participation in the plan.
To continue to participate in the plan, an individual must contribute to
the individual's health care account at least two percent (2%) of the
individual's annual household income per year or an amount
determined by the secretary that is based on the individual's annual
household income per year, but not less than one dollar ($1) per month.
The amount determined by the secretary under this subsection must be
approved by the United States Department of Health and Human
Services and must be budget neutral to the state as determined by the
state budget agency.
(d) If an applicant who is approved to participate in the plan fails to
make the initial payment into the individual's health care account, at
least the following must occur:
(1) If the individual has an annual income that is at or below one
hundred percent (100%) of the federal poverty income level, the
individual's benefits are reduced as specified in subsection (e)(1).
(2) If the individual has an annual income of more than one
hundred percent (100%) of the federal poverty income level, the
individual is not enrolled in the plan.
(e) If an enrolled individual's required monthly payment to the plan
is not made within sixty (60) days after the required payment date, the
following, at a minimum, occur:
(1) For an individual who has an annual income that is at or below
one hundred percent (100%) of the federal income poverty level,
the individual is:
(A) transferred to a plan that has a material reduction in
benefits, including the elimination of benefits for vision and
dental services; and
(B) required to make copayments for the provision of services
that may not be paid from the individual's health care account.
(2) For an individual who has an annual income of more than one
hundred percent (100%) of the federal poverty income level, the
individual shall be terminated from the plan and may not reenroll
in the plan for at least six (6) months.
(f) The state shall contribute to the individual's health care account
the difference between the individual's payment required under this
section and the plan deductible set forth in section 4.5(c) of this
chapter.
(g) A member shall remain enrolled with the same managed care
organization during the member's benefit period. A member may
change managed care organizations as follows:
(1) Without cause:
(A) before making a contribution or before finalizing
enrollment in accordance with subsection (d)(1); or
(B) during the annual plan renewal process.
(2) For cause, as determined by the office.
(h) The office may reimburse medical providers at the appropriate
Medicaid fee schedule rate for certified medical claims incurred prior
to the beginning of benefits under subsection (c) provided that the
claims:
(1) were incurred not more than thirty (30) days prior to the
individual's application; and
(2) are on behalf of an individual who:
(A) is approved to participate in the plan;
(B) is enrolled in the plan subject to the provisions in
subsection (d); and
(C) was eligible for the plan at the time care and services were
furnished.