405 IAC 10-10-5 Annual recalculation of POWER account contribution; rollover; copayment

Sec. 5. (a) A member enrolled in the Healthy Indiana Plan by December 31 may be eligible to rollover part of the member's POWER account to the new benefit period beginning January 1 of each year. (b) A member enrolled in HIP Plus or HIP State Plan Plus with a balance remaining in the member's POWER account at the end of the benefit period may be eligible to roll over a portion of the account balance to reduce such member's POWER account contributions for the new benefit period in accordance with subsection (c) or (d), as applicable. (c) If a member enrolled in HIP Plus or HIP State Plan Plus has met the member's preventive care services goals as set by the office for the expiring benefit period as set forth in 405 IAC 10-7-8, the member's final rollover amount shall be calculated as follows: (1) The member's pro-rata share is determined by adding the member's required monthly contributions owed for all enrolled months in the expiring benefit period dividing that sum by two thousand five hundred dollars ($2,500). (2) The member's portion is determined by multiplying the member's pro-rata share as determined in subdivision (1) by the amount spent from the POWER account. (3) The base rollover amount is determined by subtracting the member's portion determined under subdivision (2) by the sum of the member's paid contributions for the benefit period. (4) The final rollover amount is determined by multiplying the base rollover amount as determined in subdivision (2) by two (2). (d) If a member enrolled in HIP Plus or HIP State Plan Plus has not met the member's preventive care services goals as set by the office for the expiring benefit period as set forth in 405 IAC 10-7-8, the member's final rollover amount shall be calculated only in accordance with the base rollover amount in subsection (c)(3). Such member's base rollover amount shall not be multiplied by two (2). (e) A HIP Basic or HIP State Plan Basic member with a POWER account balance remaining at the end of the expiring benefit period shall be eligible to receive a discount on the POWER account contribution such member would need to make in order to be enrolled in the HIP Plus or HIP State Plan Plus plan for the new benefit period. The HIP Plus discount for a HIP Basic or HIP State Plan Basic member with a POWER account balance shall be calculated as follows: (1) Divide the remaining balance in the POWER account by two thousand five hundred dollars ($2,500). If the resulting percentage is less than or equal to fifty percent (50%), then that percentage shall be used in subdivision (2). However, if the resulting percentage is greater than fifty percent (50%), then the percentage shall be capped at fifty percent (50%) for purposes of subdivision (2). (2) Multiply the required monthly POWER account contribution by the percentage calculated in subdivision (1). (3) Subtract the product calculated in subdivision (2) from the POWER account contribution for the current benefit period. (f) The managed care organizations may collect member debt, if any, as calculated under section 7 of this rule, from the member portion of rollover funds calculated in either subsection (c), (d), or (e). The resulting amount shall reduce the member's annual POWER account contribution for the new benefit period. No rollover funds contributed by the state may be used to pay member debt. (g) The managed care organization shall reconcile a member's POWER account for the rollover process described in this section no later than one hundred twenty (120) days after the end of the benefit period. A member who remains enrolled in HIP Basic or HIP State Plan Basic at the time the member receives notice of the amount of the discount set forth in subsection (e) shall have a period of sixty (60) days from the date of such notice to transfer to HIP Plus or HIP State Plan Plus by making a POWER account contribution at the new discounted rate. (h) In the event the amount of the member's POWER account balance that is rolled over at the end of the benefit period exceeds the amount of the member's annual POWER account contribution for the new benefit period, the member shall not receive a refund of the excess amount. The excess funds shall be returned to the office.