Indiana Administrative Code
Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES
Article 10 - HEALTHY INDIANA PLAN
Rule 10 - POWER Accounts and Copayments
Section 10-7 - Member debt
Universal Citation: 405 IN Admin Code 10-7
Current through September 18, 2024
Authority: IC 12-15-44.5-9
Affected: IC 12-15-44.5
Sec. 7.
(a) For purposes of this section, "debt" means amounts that accrue as a result of:
(1) a managed care organization's advance
payment of the member's portion of the deductible as provided under
405
IAC 10-9-5(a)(1) that has not been
repaid through the member's POWER account contributions; or
(2) any nonsufficient funds check charges
resulting from a member's payments to a managed care organization as a result
of payment processing.
(b) A member's debt under subsection (a)(1) shall be calculated as follows:
(1) Divide
the member's annual POWER account contribution amount by two thousand five
hundred dollars ($2,500).
(2)
Multiply the amount of claims paid up to two thousand five hundred dollars
($2,500) during the benefit period by the amount determined in subdivision
(1).
(3) Subtract the total monthly
individual contributions paid by the member during the benefit period by the
amount determined under subdivision (2).
(c) A member's debt under this section shall not exceed the sum of the unpaid monthly contributions that accrued during the months in which the member received HIP Plus coverage.
(d) If a member has debt, the managed care organization may collect from the individual.
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