Section 12-15-44.5-4.7 - Application; pregnant woman exemption; payments; failure to make payments; state contribution; change in health plan(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.Amended by P.L. 152-2017,SEC. 33, eff. 7/1/2017.Added by P.L. 30-2016, SEC. 31, eff. 7/1/2016.