Indiana Administrative Code
Title 407 - OFFICE OF THE CHILDREN'S HEALTH INSURANCE PROGRAM
Article 2 - APPLICANTS AND MEMBERS; ELIGIBILITY AND ENROLLMENT; APPEAL PROCEDURES
Rule 3 - Premiums
Section 3-3 - Maximum total annual aggregate cost-sharing

Universal Citation: 407 IN Admin Code 3-3

Current through September 18, 2024

Authority: IC 12-17.6-2-11

Affected: IC 12-17.6-4-3

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.

(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.

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