405 IAC 12-3-3 Maximum total annual aggregate cost-sharing

Sec. 3. (a) The total annual aggregate cost-sharing for a family may not exceed five percent (5%) of the family's income for the twelve (12) month period beginning on the date that the child's eligibility is determined. As used in this section, "total aggregate cost-sharing" means premiums and copayments paid by the member or the member's parent or guardian. For purposes of this section, the family's income includes the income considered in 407 IAC 2-2-2 [ 405 IAC 12-2-2]. (b) The member's family is responsible for informing the local office when the total aggregate cost-sharing for the family has reached five percent (5%) of the family's income and for maintaining documentation to substantiate the amount of cost-sharing paid by the family. When the member provides the local office with documentary verification that the total aggregate cost-sharing for a family has reached five percent (5%) of the family's income for the twelve (12) month period: (1) the member's parent or guardian will not be required to pay any premiums for the remainder of the twelve (12) month period; and (2) the office will refund any copayments paid during the remainder of the twelve (12) month period.