§ 12-15-44.5-4.9 — Eligibility period; renewal; unused share of health care account distribution

Indiana § 12-15-44.5-4.9

• Jurisdiction: Indiana
• Art. 15: MEDICAID
• Ch. 44.5: Healthy Indiana Plan 2.0

Text

9. (a) An individual who is approved to
participate in the plan is eligible for a twelve (12) month plan period if
the individual continues to meet the plan requirements specified in this
chapter.
(b) If an individual chooses to renew participation in the plan, the
individual is subject to an annual renewal process at the end of the
benefit period to determine continued eligibility for participating in the
plan. If the individual does not complete the renewal process, the
individual may not reenroll in the plan for at least six (6) months.
(c) This subsection applies to participants who consistently made
the required payments in the individual's health care account. If the
individual receives the qualified preventative services recommended
to the individual during the year, the individual is eligible to have the
individual's unused share of the individual's health care account at the
end of the plan period, determined by the office, matched by the state
and carried over to the subsequent plan period to reduce the
individual's required payments. If the individual did not, during the
plan period, receive all qualified preventative services recommended
to the individual, only the nonstate contribution to the health care
account may be used to reduce the individual's payments for the
subsequent plan period.
(d) For individuals participating in the plan who, in the past, did not
make consistent payments into the individual's health care account
while participating in the plan, but:
(1) had a balance remaining in the individual's health care
account; and
(2) received all of the required preventative care services;
the office may elect to offer a discount on the individual's required
payments to the individual's health care account for the subsequent
benefit year. The amount of the discount under this subsection must be
related to the percentage of the health care account balance at the end
of the plan year but not to exceed a fifty percent (50%) discount of the
required contribution.
(e) If an individual is no longer eligible for the plan, does not renew
participation in the plan at the end of the plan period, or is terminated
from the plan for nonpayment of a required payment, the office shall,
not more than one hundred twenty (120) days after the last date of the
plan benefit period, refund to the individual the amount determined
under subsection (f) of any funds remaining in the individual's health
care account as follows:
(1) An individual who is no longer eligible for the plan or does
not renew participation in the plan at the end of the plan period
shall receive the amount determined under STEP FOUR of
subsection (f).
(2) An individual who is terminated from the plan due to
nonpayment of a required payment shall receive the amount
determined under STEP SIX of subsection (f).
The office may charge a penalty for any voluntary withdrawals from the
health care account by the individual before the end of the plan benefit
year. The individual may receive the amount determined under STEP
SIX of subsection (f).
(f) The office shall determine the amount payable to an individual
described in subsection (e) as follows:
STEP ONE: Determine the total amount paid into the individual's
health care account under this chapter.
STEP TWO: Determine the total amount paid into the individual's
health care account from all sources.
STEP THREE: Divide STEP ONE by STEP TWO.
STEP FOUR: Multiply the ratio determined in STEP THREE by
the total amount remaining in the individual's health care account.
STEP FIVE: Subtract any nonpayments of a required payment.
STEP SIX: Multiply the amount determined under STEP FIVE by
at least seventy-five hundredths (0.75).

Legislative History

As added by P.L.30-2016, SEC.32. Amended by P.L.114-2018, SEC.6.