405 IAC 10-10-13 Exceptions to nonpayment penalties and plan lockout periods

Sec. 13. (a) A member exempt from cost sharing pursuant to section 3(d) of this rule shall not be subject to any of the nonpayment penalties set forth in section 12(a) of this rule. (b) A medically frail individual with household income over one hundred percent (100%) of the FPL shall not be subject to disenrollment for nonpayment under section 12(a)(1) of this rule, but shall: (1) remain in HIP State Plan Plus; (2) be required to pay copayments as set forth in section 3(c) of this rule; and (3) continue to be billed for monthly POWER account contributions and accrue debt to the managed care organization. Such member shall no longer be subject to the copayment requirement under subsection (b)(2) if, at the member's annual renewal, the member pays the first month POWER account contribution in the new benefit period. (c) A member disenrolled under section 12(a) of this rule or 405 IAC 10-4-9 may reenroll in the plan prior to the expiration of the six (6) month lockout period if such individual is determined to be medically frail during the lockout period. Such individual shall reapply for the plan and be verified as medically frail in accordance with 405 IAC 10-6-1(e) before the individual may be reenrolled in the plan under this subsection. (d) A member disenrolled under section 12(a) of this rule or 405 IAC 10-4-9 shall not be subject to the six (6) month lockout period but may be reinstated to the plan prior to the expiration of the six (6) month lockout, if a new application is filed and the individual can provide verification that one (1) of the following qualifying events caused the disenrollment: (1) Obtained and subsequently lost private insurance coverage. (2) Had a loss of income after disqualification due to increased income. (3) Took up residence in another state and later returned. (4) Was a victim of domestic violence. (5) Was residing in a county subject to a disaster declaration made in accordance with IC 10-14-3-12 at any time during the sixty (60) calendar days prior to or including the date such member was terminated from the plan.