Section 405 IAC 10-10-6 - POWER account balance; termination and disenrollmentAuthority: IC 12-15-44.5-9
Affected: IC 12-15-44.5; IC 32-34-1
Sec. 6.
(a) If a member loses plan eligibility due to nonpayment of POWER account contributions as specified in section 12 of this rule, the member shall be paid only a portion of the balance remaining in the member's POWER account as calculated in subsection (b).(b) If a member loses plan eligibility for reasons set forth in subsection (a), the member refund shall be calculated as follows:(1) Divide the sum of total contributions owed by the member for enrolled months during the benefit period by two thousand five hundred dollars ($2,500).(2) Multiply the ratio calculated in subdivision (1) by the total amount spent from the individual's POWER account.(3) Sum total contributions made towards the member's required monthly contributions and subtract the member share calculated in subdivision (2). Where the result is positive the member shall be due a refund. Where the result is negative the member may have debt as calculated under section 7 of this rule.(4) Multiply the amount calculated in subdivision (3) by seventy-five hundredths (.75) to determine the amount to be returned to the individual.(c) If a member loses plan eligibility for reasons other than those set forth in subsection (a), the member shall be paid a portion of the balance remaining in the member's POWER account, calculated as follows:(1) Divide the sum of total contributions owed by the member for enrolled months during the benefit period by two thousand five hundred dollars ($2,500).(2) Multiply the ratio calculated in subdivision (1) by the total amount spent from the individual's POWER account.(3) Sum total contributions made towards the member's required monthly contributions and subtract the member share calculated in subdivision (2). Where the result is positive the member may be due a refund. Where the result is negative the member may have debt, as calculated under section 7 of this rule.(d) The managed care organization shall return the amount calculated in subsection (b) or (c) to the member within one hundred and twenty (120) days of the last date of the plan benefit period. The former member shall be liable for the POWER account portion of any claims for covered services with dates of service occurring during the prior benefit period but after the POWER account balance has been paid to the former member. The former member shall not be liable for claims originally denied but overturned on appeal if the appealed claim is paid more than one hundred twenty (120) days following the member's last date of participation in the plan.(e) After payment to the member of the amount calculated in subsection (b) or (c), the state shall retain any remaining POWER account balance.(f) In the event that a member: (1) cannot be located; or(2) otherwise does not claim the amount calculated in subsection (b) or (c); such amount shall be treated as unclaimed property and shall be subject to the Unclaimed Property Act, IC 32-34-1.
Filed 5/18/2015, 12:34 p.m.: 20150617-IR-405140339FRAFiled 1/19/2018, 8:42 a.m.: 20180214-IR-405170484FRA