Common use of Disenrollment Exceptions Clause in Contracts

Disenrollment Exceptions. The following members will not be subject to disenrollment due to non- payment: Members confirmed medically frail in accordance with Section 3.3.2 will not be terminated from the program due to non-payment. In the event a medically frail member with income over 100% FPL does not make a payment within sixty (60) calendar days of its due date, the Contractor shall notify the State of nonpayment as detailed in Section 4.7. However, the medically frail member will continue to receive HIP State Plan benefits, but will be required to make copayments consistent with Section 4.1.2. The Contractor shall continue to send monthly POWER Account invoices to such medically frail members above 100% FPL, and the member will continue to incur debt to the Contractor for unpaid POWER Account contributions. The Contractor shall ensure that the member’s total expenses, including any paid debt, copayments, and POWER account contributions, do not exceed the five percent (5%) of income maximum during any quarter as set forth in Section 6.16. Members may regain access to HIP State Plan Plus without copayments during their 12-month eligibility redetermination in accordance with Section 5.6. i. Parent/caretaker members receiving transitional medical assistance (TMA) as set forth in Section 3.3.1 shall either attain or remain in HIP Plus coverage for up to twelve (12) months during their TMA eligibility period as long as POWER Account contributions are made. If after the first six (6) months of TMA coverage income remains over 138% but below 185% FPL, coverage can extend an additional six (6) months as long as POWER Account contributions are paid.