Common use of Enrollment and Initial POWER Account Contributions Clause in Contracts

Enrollment and Initial POWER Account Contributions. 4.6.1 Standard Enrollment The standard initial billing and enrollment process described in this Section 4.6.1 shall be in effect for all applicants. The Contractor shall be required to comply with the fast track initial billing and enrollment process described in Section 4.6.2 below for all fast track eligible applicants identified by the State. Except for American Indian/ Alaska Native (AI/AN) members, HIP member eligibility shall not be final until the first day of the month in which either (i) the POWER Account contribution is paid, or (ii) non-payment is determined for individuals at or below 100% FPL who choose not to participate in HIP Plus. A member’s initial POWER Account contribution is due within sixty (60) calendar days of the date the Contractor receives a member’s conditionally eligible file from the State. The Contractor shall receive conditional eligibility files of individuals that selected, or were auto-assigned to, the Contractor’s plan from the State. Within three (3) business days of receiving the conditional eligibility file, the Contractor shall send a Welcome Letter and initial invoice to the individual for their first POWER Account contribution. The first invoice shall reflect the member’s monthly POWER Account contribution as determined by the State. The Welcome Letter shall include a notice explaining that the individual shall submit their initial payment within sixty (60) calendar days in order to receive HIP Plus benefits. The notice shall be tailored to individuals at or below 100% FPL and those above 100% FPL. The Welcome Letter to individuals above 100% FPL shall explain that if the initial payment is not received within sixty (60) calendar days, the member’s coverage will not commence and they will have to reapply for HIP. The Welcome Letter to individuals at or below 100% FPL shall explain that if the initial payment is not received within sixty (60) calendar days, their coverage under HIP Basic will begin on the first day of the month in which the sixty (60) day period ends. The Welcome Letter shall also have a notice prominently displayed on the first page stating in substance that the individual has the right to select another MCE before the first payment is made. Such notice shall include information for how the individual may contact the enrollment broker to change MCEs. As with all member communications, the Welcome Letter shall be reviewed and approved by the State prior to use in accordance with Section 7.1. The Contractor shall provide at least two reminders to individuals who have not made their first monthly POWER Account contribution. Except for AI/AN members, an individual’s enrollment in the Contractor’s plan begins the first day of the month in which the first POWER Account contribution is processed, or after the nonpayment determination has been made for individuals eligible for HIP Basic or HIP State Plan Basic. The Contractor shall process all payments and notify the State of the payment within fifteen (15) calendar days of receiving the payment. The fifteen (15) calendar day period allows time to assure that payments made by check have cleared. Members identified as an AI/AN pursuant to 42 CFR 136.12 are exempt from all cost-sharing, as set forth in Section 4.1.4, and therefore such member’s enrollment in the Contractor’s HIP Plus plan begins the first day of the month in which the member applied to the plan. 4.6.2 Fast Track Enrollment Except for AI/AN members, HIP eligibility shall not be final until either (i) the first day of the month in which the member pays an initial contribution to their POWER Account, or (ii) until the first day of the month in which the initial POWER Account fast track prepayment period expires for individuals at or below 100% FPL who choose not to participate in HIP Plus. For purposes of clarification, a member may enroll in HIP Plus by choosing to pay an initial ten dollar ($10.00) fast track POWER Account prepayment or the member’s first month’s POWER Account contribution in an amount determined by the State. Fast track eligible applicants will be provided the opportunity to pay a ten dollar ($10.00) initial fast track POWER Account prepayment that expedites enrollment into the HIP Plus plan once an individual has been determined eligible by the State. The applicant may pay the fast track prepayment either immediately at the time of application or following receipt of a fast track invoice from the applicant’s MCE. For applicants that select an MCE and elect to pay via credit card at the time of application, the State will connect the applicant directly to the selected MCE’s third party payment partner to collect and process each applicant’s credit card payment. The Contractor shall store the application ID number, payment amount, and payment date at least until the date the Contractor is notified by the State of the applicant’s final eligibility determination. The Contractor shall receive pending eligibility files of individuals that selected, or were auto-assigned to, their plan from the State and meet fast track eligibility criteria. The Contractor shall review all pending eligibility files and identify applicants who have provided payment information to the Contractor via the Indiana Health Coverage Program application. If the Contractor successfully verifies the payment, the Contractor shall send the State notice of payment within one (1) business day of receiving the pending eligibility file. Within two (2) business day of receiving the pending eligibility file of either (i) an applicant who did not pay the fast track payment via credit card on the Indiana Health Coverage Application or (ii) whose credit card information was unable to be successfully verified and/or processed, the Contractor shall send an initial invoice to the individual for a ten dollar ($10.00) POWER Account fast track prepayment. The invoice shall include a notice explaining that the individual has not yet been determined eligible for HIP benefits, but the initial fast track prepayment shall be paid within sixty (60) calendar days in order for the potential member to be eligible to receive HIP Plus benefits. The notice shall encourage prompt payment of the fast track prepayment which could advance the potential member’s benefit start date. Further, the initial invoice shall also include a prominent notice stating in substance that the potential member has the right to select another MCE at any time before the first payment is made. Such notice shall include information for how the potential member may contact the enrollment broker to change MCEs. In addition, the notice shall clearly indicate that the fast track prepayment is an optional payment that either (i) will be fully refunded to the individual in the event the pending applicant is determined by the State not to be eligible for HIP, or (ii) will be applied towards the member’s future required POWER Account contribution(s) in the event the potential member is determined eligible for HIP. The notice shall explain that if the member is determined eligible for HIP, their monthly POWER account contributions may be greater than the initial fast track prepayment, in which case, the member may owe more in the second month in order to continue to receive HIP Plus benefits. As with all member communications, the fast track enrollment notice shall be reviewed and approved by the State prior to use in accordance with Section 7.1. A member’s fast track prepayment or initial POWER Account contribution is due within sixty (60) calendar days of the date the Contractor receives the member’s pending eligibility file from the State. The Contractor shall provide at least two (2) reminders during the sixty (60) day payment period to individuals who have not made their initial fast track prepayment or first monthly POWER Account contribution. The Contractor shall process all payments and notify the State of the payment within fifteen (15) calendar days of receiving the payment. The fifteen (15) calendar day period allows time to assure that payments made by check have cleared. Notwithstanding the foregoing, the Contractor may elect to hold fast track prepayments received from applicants not yet determined eligible by the State until such time the applicant is determined eligible. If the Contractor elects to hold such payments, the Contractor shall verify the payment and notify the State of receipt of a valid payment method within fifteen (15) calendar days of receipt. Once the applicant is determined eligible, the Contractor shall release the hold and process payment no later than fifteen (15) calendar days from the Contractor’s receipt of the eligibility file. A member’s enrollment in the Contractor’s plan begins as follows: i. If the member pays either the fast track prepayment or the initial POWER Account contribution within the original sixty (60) day fast track payment period, the effective date of coverage is the first day of the month in which the member made his or her initial payment. Potential members who pay the fast track prepayment prior to the State’s eligibility determination will be directly opened into HIP Plus benefits upon the State’s final eligibility determination. ii. Members who have an open presumptive eligibility segment and make a fast track payment with their full IHCP application will open into HIP Plus the first day of the month following their fast track payment. iii. If the potential member does not pay the fast track prepayment or their initial POWER Account contribution within the sixty (60) day payment period but is found otherwise eligible for HIP, the potential member will become conditionally eligible for HIP following the eligibility determination, and either: a. the effective date of coverage will be the first day of the month in which the sixty (60) day fast track prepayment period expired for individuals below 100% FPL or who are otherwise exempt from non-payment penalties in accordance with Section 4.7.1; or b. the individual will be determined ineligible and will have to reapply for HIP benefits if the individual is over 100% FPL and is not otherwise exempt from non-payment penalties in accordance with Section 4.7.1. iv. Members identified as an AI/AN pursuant to 42 CFR 136.12 are exempt from all cost-sharing, as set forth in Section 4.1.4, and therefore, unless such member opts of out managed care via the process determined by the State, such member’s enrollment in the Contractor’s HIP Plus or HIP State Plan Plus plan, as applicable, begins the first day of the month in which the individual applied for the plan. As described in subsection (ii) above, a potential member who is determined eligible for HIP by the State before the initial fast track prepayment was received and prior to the expiration of the sixty (60) day fast track payment period, will be considered conditionally eligible. Within three (3) business days of receiving the conditionally eligible file, the Contractor shall send a Welcome Letter to the conditionally eligible member. The Welcome Letter shall be tailored to individuals at or below 100% FPL and those above 100% FPL. a. The Welcome Letter to members above 100% FPL shall explain that if either the initial fast track prepayment or full POWER Account contribution is not received prior to the expiration of the sixty (60) day fast track payment period, the member’s coverage will not commence and they will have to reapply for HIP. b. The Welcome Letter to members at or below 100% FPL shall explain that if either the initial fast track prepayment or full POWER Account contribution is not received prior to the expiration of the sixty (60) day fast track payment period, the member’s coverage under HIP Basic will begin on the first day of the month in which the payment period expires. The Contractor’s Welcome Letter to all conditionally eligible members who have not yet made a fast track prepayment shall include a notice that if the member’s POWER Account contribution is greater than ten dollars ($10.00) the initial fast track prepayment is the minimum required to obtain HIP Plus benefits and start the program, however, the member will remain responsible for the full amount of the POWER Account contribution during the first month of coverage and such amount will be included on the subsequent month POWER Account invoice. The Welcome Letter shall also have a notice prominently displayed on the first page stating in substance that the individual has the right to select another MCE at any time before the first payment is made. Such notice shall include information for how the individual may contact the enrollment broker to change MCEs. As with all member communications, the Welcome Letter shall be reviewed and approved by the State prior to use in accordance with Section 7.1. Due to the fact that the Contractor may collect the initial fast track prepayment before the member’s individual POWER Account contribution has been determined by the State, the Contractor will be required to reconcile any overpayments or underpayments resulting from the fast track prepayment. Specifically, if the member’s POWER Account contribution is less than the fast track prepayment, the Contractor shall credit the fast track prepayment against the member’s required POWER Account contributions on a first month’s basis. For example, for a member with a $1.00 per month contribution, the Contractor shall immediately credit the member’s account and apply the payment to cover the first ten months of required member contributions. By contrast, if the member’s POWER Account contribution is greater than the fast track prepayment, the Contractor shall credit the fast track prepayment to the member’s first month’s required POWER Account contribution and add the remaining balance to the member’s subsequent POWER Account contribution. The member will have sixty (60) calendar days to pay the remaining balance. For individuals who pay their fast track prepayment within the sixty (60) day payment period but who are determined ineligible for HIP, the Contractor shall return any such funds within ten (10) business days of the determination.

Enrollment and Initial POWER Account Contributions. 4.6.1 Standard Enrollment The standard initial billing and enrollment process described in this Section Section 4.6.1 shall be in effect for all applicants. The Contractor shall be required to comply with the fast track initial billing and enrollment process described in Section 4.6.2 below for all fast track eligible applicants identified by the State. Except for American Indian/ Alaska Native (AI/AN) members, HIP member eligibility shall not be final until the first day of the month in which either (i) the POWER Account contribution is paid, or (ii) non-payment is determined for individuals at or below 100% FPL who choose not to participate in HIP Plus. A member’s initial POWER Account contribution is due within sixty (60) calendar days of the date the Contractor receives a member’s conditionally eligible file from the State. The Contractor shall receive conditional eligibility files of individuals that selected, or were auto-assigned to, the Contractor’s plan from the State. Within three (3) business days of receiving the conditional eligibility file, the Contractor shall send a Welcome Letter and initial invoice to the individual for their first POWER Account contribution. The first invoice shall reflect the member’s monthly POWER Account contribution as determined by the State. The Welcome Letter shall include a notice explaining that the individual shall submit their initial payment within sixty (60) calendar days in order to receive HIP Plus benefits. The notice shall be tailored to individuals at or below 100% FPL and those above 100% FPL. The Welcome Letter to individuals above 100% FPL shall explain that if the initial payment is not received within sixty (60) calendar days, the member’s coverage will not commence and they will have to reapply for HIP. The Welcome Letter to individuals at or below 100% FPL shall explain that if the initial payment is not received within sixty (60) calendar days, their coverage under HIP Basic will begin on the first day of the month in which the sixty (60) day period ends. The Welcome Letter shall also have a notice prominently displayed on the first page stating in substance that the individual has the right to select another MCE before the first payment is made. Such notice shall include information for how the individual may contact the enrollment broker to change MCEs. As with all member communications, the Welcome Letter shall be reviewed and approved by the State prior to use in accordance with Section 7.1. The Contractor shall provide at least two reminders to individuals who have not made their first monthly POWER Account contribution. Except for AI/AN members, an individual’s enrollment in the Contractor’s plan begins the first day of the month in which the first POWER Account contribution is processed, or after the nonpayment determination has been made for individuals eligible for HIP Basic or HIP State Plan Basic. The Contractor shall process all payments and notify the State of the payment within fifteen (15) calendar days of receiving the payment. The fifteen (15) calendar day period allows time to assure that payments made by check have cleared. Members identified as an AI/AN pursuant to 42 CFR 136.12 are exempt from all cost-sharing, as set forth in Section 4.1.4, and therefore such member’s enrollment in the Contractor’s HIP Plus plan begins the first day of the month in which the member applied to the plan. 4.6.2 Fast Track Enrollment Except for AI/AN members, HIP eligibility shall not be final until either (i) the first day of the month in which the member pays an initial contribution to their POWER Account, or (ii) until the first day of the month in which the initial POWER Account fast track prepayment period expires for individuals at or below 100% FPL who choose not to participate in HIP Plus. For purposes of clarification, a member may enroll in HIP Plus by choosing to pay an initial ten dollar ($10.00) fast track POWER Account prepayment or the member’s first month’s POWER Account contribution in an amount determined by the State. Fast track eligible applicants will be provided the opportunity to pay a ten dollar ($10.00) initial fast track POWER Account prepayment that expedites enrollment into the HIP Plus plan once an individual has been determined eligible by the State. The applicant may pay the fast track prepayment either immediately at the time of application or following receipt of a fast track invoice from the applicant’s MCE. For applicants that select an MCE and elect to pay via credit card at the time of application, the State will connect the applicant directly to the selected MCE’s third party payment partner to collect and process each applicant’s credit card payment. The Contractor shall store the application ID number, payment amount, and payment date at least until the date the Contractor is notified by the State of the applicant’s final eligibility determination. The Contractor shall receive pending eligibility files of individuals that selected, or were auto-assigned to, their plan from the State and meet fast track eligibility criteria. The Contractor shall review all pending eligibility files and identify applicants who have provided payment information to the Contractor via the Indiana Health Coverage Program application. If the Contractor successfully verifies the payment, the Contractor shall send the State notice of payment within one (1) business day of receiving the pending eligibility file. Within two (2) business day of receiving the pending eligibility file of either (i) an applicant who did not pay the fast track payment via credit card on the Indiana Health Coverage Application or (ii) whose credit card information was unable to be successfully verified and/or processed, the Contractor shall send an initial invoice to the individual for a ten dollar ($10.00) POWER Account fast track prepayment. The invoice shall include a notice explaining that the individual has not yet been determined eligible for HIP benefits, but the initial fast track prepayment shall be paid within sixty (60) calendar days in order for the potential member to be eligible to receive HIP Plus benefits. The notice shall encourage prompt payment of the fast track prepayment which could advance the potential member’s benefit start date. Further, the initial invoice shall also include a prominent notice stating in substance that the potential member has the right to select another MCE at any time before the first payment is made. Such notice shall include information for how the potential member may contact the enrollment broker to change MCEs. In addition, the notice shall clearly indicate that the fast track prepayment is an optional payment that either (i) will be fully refunded to the individual in the event the pending applicant is determined by the State not to be eligible for HIP, or (ii) will be applied towards the member’s future required POWER Account contribution(s) in the event the potential member is determined eligible for HIP. The notice shall explain that if the member is determined eligible for HIP, their monthly POWER account contributions may be greater than the initial fast track prepayment, in which case, the member may owe more in the second month in order to continue to receive HIP Plus benefits. As with all member communications, the fast track enrollment notice shall be reviewed and approved by the State prior to use in accordance with Section 7.1. A member’s fast track prepayment or initial POWER Account contribution is due within sixty (60) calendar days of the date the Contractor receives the member’s pending eligibility file from the State. The Contractor shall provide at least two (2) reminders during the sixty (60) day payment period to individuals who have not made their initial fast track prepayment or first monthly POWER Account contribution. The Contractor shall process all payments and notify the State of the payment within fifteen (15) calendar days of receiving the payment. The fifteen (15) calendar day period allows time to assure that payments made by check have cleared. Notwithstanding the foregoing, the Contractor may elect to hold fast track prepayments received from applicants not yet determined eligible by the State until such time the applicant is determined eligible. If the Contractor elects to hold such payments, the Contractor shall verify the payment and notify the State of receipt of a valid payment method within fifteen (15) calendar days of receipt. Once the applicant is determined eligible, the Contractor shall release the hold and process payment no later than fifteen (15) calendar days from the Contractor’s receipt of the eligibility file. A member’s enrollment in the Contractor’s plan begins as follows: i. If the member pays either the fast track prepayment or the initial POWER Account contribution within the original sixty (60) day fast track payment period, the effective date of coverage is the first day of the month in which the member made his or her initial payment. Potential members who pay the fast track prepayment prior to the State’s eligibility determination will be directly opened into HIP Plus benefits upon the State’s final eligibility determination. ii. Members who have an open presumptive eligibility segment and make a fast track payment with their full IHCP application will open into HIP Plus the first day of the month following their fast track payment. iii. If the potential member does not pay the fast track prepayment or their initial POWER Account contribution within the sixty (60) day payment period but is found otherwise eligible for HIP, the potential member will become conditionally eligible for HIP following the eligibility determination, and either: a. the effective date of coverage will be the first day of the month in which the sixty (60) day fast track prepayment period expired for individuals below 100% FPL or who are otherwise exempt from non-payment penalties in accordance with Section 4.7.1; or b. the individual will be determined ineligible and will have to reapply for HIP benefits if the individual is over 100% FPL and is not otherwise exempt from non-payment penalties in accordance with Section 4.7.1. iv. Members identified as an AI/AN pursuant to 42 CFR 136.12 are exempt from all cost-sharing, as set forth in Section 4.1.4, and therefore, unless such member opts of out managed care via the process determined by the State, such member’s enrollment in the Contractor’s HIP Plus or HIP State Plan Plus plan, as applicable, begins the first day of the month in which the individual applied for the plan. As described in subsection (ii) above, a potential member who is determined eligible for HIP by the State before the initial fast track prepayment was received and prior to the expiration of the sixty (60) day fast track payment period, will be considered conditionally eligible. Within three (3) business days of receiving the conditionally eligible file, the Contractor shall send a Welcome Letter to the conditionally eligible member. The Welcome Letter shall be tailored to individuals at or below 100% FPL and those above 100% FPL. a. The Welcome Letter to members above 100% FPL shall explain that if either the initial fast track prepayment or full POWER Account contribution is not received prior to the expiration of the sixty (60) day fast track payment period, the member’s coverage will not commence and they will have to reapply for HIP. b. The Welcome Letter to members at or below 100% FPL shall explain that if either the initial fast track prepayment or full POWER Account contribution is not received prior to the expiration of the sixty (60) day fast track payment period, the member’s coverage under HIP Basic will begin on the first day of the month in which the payment period expires. The Contractor’s Welcome Letter to all conditionally eligible members who have not yet made a fast track prepayment shall include a notice that if the member’s POWER Account contribution is greater than ten dollars ($10.00) the initial fast track prepayment is the minimum required to obtain HIP Plus benefits and start the program, however, the member will remain responsible for the full amount of the POWER Account contribution during the first month of coverage and such amount will be included on the subsequent month POWER Account invoice. The Welcome Letter shall also have a notice prominently displayed on the first page stating in substance that the individual has the right to select another MCE at any time before the first payment is made. Such notice shall include information for how the individual may contact the enrollment broker to change MCEs. As with all member communications, the Welcome Letter shall be reviewed and approved by the State prior to use in accordance with Section 7.1. Due to the fact that the Contractor may collect the initial fast track prepayment before the member’s individual POWER Account contribution has been determined by the State, the Contractor will be required to reconcile any overpayments or underpayments resulting from the fast track prepayment. Specifically, if the member’s POWER Account contribution is less than the fast track prepayment, the Contractor shall credit the fast track prepayment against the member’s required POWER Account contributions on a first month’s basis. For example, for a member with a $1.00 per month contribution, the Contractor shall immediately credit the member’s account and apply the payment to cover the first ten months of required member contributions. By contrast, if the member’s POWER Account contribution is greater than the fast track prepayment, the Contractor shall credit the fast track prepayment to the member’s first month’s required POWER Account contribution and add the remaining balance to the member’s subsequent POWER Account contribution. The member will have sixty (60) calendar days to pay the remaining balance. For individuals who pay their fast track prepayment within the sixty (60) day payment period but who are determined ineligible for HIP, the Contractor shall return any such funds within ten (10) business days of the determination.sixty

Enrollment and Initial POWER Account Contributions. 4.6.1 Standard Enrollment The standard initial billing and enrollment process described in this Section 4.6.1 shall be in effect for all applicants. The Contractor shall be required to comply with the fast track -track initial billing and enrollment process described in Section 4.6.2 below for all fast fast-track eligible applicants identified by the State. Except for American Indian/ Alaska Native (AI/AN) members, HIP member eligibility shall not be final until the first day of the month in which either (i) the POWER Account contribution is paid, or (ii) non-payment is determined for individuals at or below 100% FPL who choose not to participate in HIP Plus. A member’s initial POWER Account contribution is due within sixty (60) calendar days of the date the Contractor receives a member’s conditionally eligible file from the State. The Contractor shall receive conditional eligibility files of individuals that selected, or were auto-auto assigned to, the Contractor’s plan from the State. Within three (3) business days of receiving the conditional eligibility file, the Contractor shall send a Welcome Letter and initial invoice to the individual for their first POWER Account contribution. The first invoice shall reflect the member’s monthly POWER Account contribution as determined by the State. The Welcome Letter shall include a notice explaining that the individual shall submit their initial payment within sixty (60) calendar days in order to receive HIP Plus benefits. The notice shall be tailored to individuals at or below 100% FPL and those above 100% FPL. The Welcome Letter to individuals above 100% FPL shall explain that if the initial payment is not received within sixty (60) calendar days, the member’s coverage will not commence commence, and they will have to reapply for HIP. The Welcome Letter to individuals at or below 100% FPL shall explain that if the initial payment is not received within sixty (60) calendar days, their coverage under HIP Basic will begin on the first day of the month in which the sixty (60) day period ends. The Welcome Letter shall also have a notice prominently displayed on the first page stating in substance that the individual has the right to select another MCE before the first payment is made. Such notice shall include information for how the individual may contact the enrollment broker to change MCEs. As with all member communications, the Welcome Letter shall be reviewed and approved by the State prior to use in accordance with Section 7.1. The Contractor shall provide at least two reminders to individuals who have not made their first monthly POWER Account contribution. Except for AI/AN members, an individual’s enrollment in the Contractor’s plan begins the first day of the month in which the first POWER Account contribution is processed, or after the nonpayment determination has been made for individuals eligible for HIP Basic or HIP State Plan Basic. The Contractor shall process all payments and notify the State of the payment within fifteen (15) calendar days of receiving the payment. The fifteen (15) calendar day period allows time to assure that payments made by check have cleared. Members identified as an AI/AN pursuant to 42 CFR 136.12 are exempt from all cost-cost- sharing, as set forth in Section 4.1.4, and therefore such member’s enrollment in the Contractor’s HIP Plus plan begins the first day of the month in which the member applied to the plan. 4.6.2 Fast Track Enrollment Except for AI/AN members, HIP eligibility shall not be final until either (i) the first day of the month in which the member pays an initial contribution to their POWER Account, or (ii) until the first day of the month in which the initial POWER Account fast track prepayment period expires for individuals at or below 100% FPL who choose not to participate in HIP Plus. For purposes of clarification, a member may enroll in HIP Plus by choosing to pay an initial ten dollar ($10.00) fast track POWER Account prepayment or the member’s first month’s POWER Account contribution in an amount determined by the State. Fast track eligible applicants will be provided the opportunity to pay a ten dollar ($10.00) initial fast track POWER Account prepayment that expedites enrollment into the HIP Plus plan once an individual has been determined eligible by the State. The applicant may pay the fast track prepayment either immediately at the time of application or following receipt of a fast track invoice from the applicant’s MCE. For applicants that select an MCE and elect to pay via credit card at the time of application, the State will connect the applicant directly to the selected MCE’s third party payment partner to collect and process each applicant’s credit card payment. The Contractor shall store the application ID number, payment amount, and payment date at least until the date the Contractor is notified by the State of the applicant’s final eligibility determination. The Contractor shall receive pending eligibility files of individuals that selected, or were auto-assigned to, their plan from the State and meet fast track eligibility criteria. The Contractor shall review all pending eligibility files and identify applicants who have provided payment information to the Contractor via the Indiana Health Coverage Program application. If the Contractor successfully verifies the payment, the Contractor shall send the State notice of payment within one (1) business day of receiving the pending eligibility file. Within two (2) business day of receiving the pending eligibility file of either (i) an applicant who did not pay the fast track payment via credit card on the Indiana Health Coverage Application or (ii) whose credit card information was unable to be successfully verified and/or processed, the Contractor shall send an initial invoice to the individual for a ten dollar ($10.00) POWER Account fast track prepayment. The invoice shall include a notice explaining that the individual has not yet been determined eligible for HIP benefits, but the initial fast track prepayment shall be paid within sixty (60) calendar days in order for the potential member to be eligible to receive HIP Plus benefits. The notice shall encourage prompt payment of the fast track prepayment which could advance the potential member’s benefit start date. Further, the initial invoice shall also include a prominent notice stating in substance that the potential member has the right to select another MCE at any time before the first payment is made. Such notice shall include information for how the potential member may contact the enrollment broker to change MCEs. In addition, the notice shall clearly indicate that the fast track prepayment is an optional payment that either (i) will be fully refunded to the individual in the event the pending applicant is determined by the State not to be eligible for HIP, or (ii) will be applied towards the member’s future required POWER Account contribution(s) in the event the potential member is determined eligible for HIP. The notice shall explain that if the member is determined eligible for HIP, their monthly POWER account contributions may be greater than the initial fast track prepayment, in which case, the member may owe more in the second month in order to continue to receive HIP Plus benefits. As with all member communications, the fast track enrollment notice shall be reviewed and approved by the State prior to use in accordance with Section 7.1. A member’s fast track prepayment or initial POWER Account contribution is due within sixty (60) calendar days of the date the Contractor receives the member’s pending eligibility file from the State. The Contractor shall provide at least two (2) reminders during the sixty (60) day payment period to individuals who have not made their initial fast track prepayment or first monthly POWER Account contribution. The Contractor shall process all payments and notify the State of the payment within fifteen (15) calendar days of receiving the payment. The fifteen (15) calendar day period allows time to assure that payments made by check have cleared. Notwithstanding the foregoing, the Contractor may elect to hold fast track prepayments received from applicants not yet determined eligible by the State until such time the applicant is determined eligible. If the Contractor elects to hold such payments, the Contractor shall verify the payment and notify the State of receipt of a valid payment method within fifteen (15) calendar days of receipt. Once the applicant is determined eligible, the Contractor shall release the hold and process payment no later than fifteen (15) calendar days from the Contractor’s receipt of the eligibility file. A member’s enrollment in the Contractor’s plan begins as follows: i. If the member pays either the fast track prepayment or the initial POWER Account contribution within the original sixty (60) day fast track payment period, the effective date of coverage is the first day of the month in which the member made his or her initial payment. Potential members who pay the fast track prepayment prior to the State’s eligibility determination will be directly opened into HIP Plus benefits upon the State’s final eligibility determination. ii. Members who have an open presumptive eligibility segment and make a fast track payment with their full IHCP application will open into HIP Plus the first day of the month following their fast track payment. iii. If the potential member does not pay the fast track prepayment or their initial POWER Account contribution within the sixty (60) day payment period but is found otherwise eligible for HIP, the potential member will become conditionally eligible for HIP following the eligibility determination, and either: a. the effective date of coverage will be the first day of the month in which the sixty (60) day fast track prepayment period expired for individuals below 100% FPL or who are otherwise exempt from non-payment penalties in accordance with Section 4.7.1; or b. the individual will be determined ineligible and will have to reapply for HIP benefits if the individual is over 100% FPL and is not otherwise exempt from non-payment penalties in accordance with Section 4.7.1. iv. Members identified as an AI/AN pursuant to 42 CFR 136.12 are exempt from all cost-sharing, as set forth in Section 4.1.4, and therefore, unless such member opts of out managed care via the process determined by the State, such member’s enrollment in the Contractor’s HIP Plus or HIP State Plan Plus plan, as applicable, begins the first day of the month in which the individual applied for the plan. As described in subsection (ii) above, a potential member who is determined eligible for HIP by the State before the initial fast track prepayment was received and prior to the expiration of the sixty (60) day fast track payment period, will be considered conditionally eligible. Within three (3) business days of receiving the conditionally eligible file, the Contractor shall send a Welcome Letter to the conditionally eligible member. The Welcome Letter shall be tailored to individuals at or below 100% FPL and those above 100% FPL. a. The Welcome Letter to members above 100% FPL shall explain that if either the initial fast track prepayment or full POWER Account contribution is not received prior to the expiration of the sixty (60) day fast track payment period, the member’s coverage will not commence and they will have to reapply for HIP. b. The Welcome Letter to members at or below 100% FPL shall explain that if either the initial fast track prepayment or full POWER Account contribution is not received prior to the expiration of the sixty (60) day fast track payment period, the member’s coverage under HIP Basic will begin on the first day of the month in which the payment period expires. The Contractor’s Welcome Letter to all conditionally eligible members who have not yet made a fast track prepayment shall include a notice that if the member’s POWER Account contribution is greater than ten dollars ($10.00) the initial fast track prepayment is the minimum required to obtain HIP Plus benefits and start the program, however, the member will remain responsible for the full amount of the POWER Account contribution during the first month of coverage and such amount will be included on the subsequent month POWER Account invoice. The Welcome Letter shall also have a notice prominently displayed on the first page stating in substance that the individual has the right to select another MCE at any time before the first payment is made. Such notice shall include information for how the individual may contact the enrollment broker to change MCEs. As with all member communications, the Welcome Letter shall be reviewed and approved by the State prior to use in accordance with Section 7.1. Due to the fact that the Contractor may collect the initial fast track prepayment before the member’s individual POWER Account contribution has been determined by the State, the Contractor will be required to reconcile any overpayments or underpayments resulting from the fast track prepayment. Specifically, if the member’s POWER Account contribution is less than the fast track prepayment, the Contractor shall credit the fast track prepayment against the member’s required POWER Account contributions on a first month’s basis. For example, for a member with a $1.00 per month contribution, the Contractor shall immediately credit the member’s account and apply the payment to cover the first ten months of required member contributions. By contrast, if the member’s POWER Account contribution is greater than the fast track prepayment, the Contractor shall credit the fast track prepayment to the member’s first month’s required POWER Account contribution and add the remaining balance to the member’s subsequent POWER Account contribution. The member will have sixty (60) calendar days to pay the remaining balance. For individuals who pay their fast track prepayment within the sixty (60) day payment period but who are determined ineligible for HIP, the Contractor shall return any such funds within ten (10) business days of the determination.

Enrollment and Initial POWER Account Contributions. 4.6.1 Standard Enrollment The standard initial billing and enrollment process described in this Section 4.6.1 shall be in effect for all applicants. The Contractor shall be required to comply with the fast fast-track initial billing and enrollment process described in Section 4.6.2 below for all fast fast-track eligible applicants identified by the State. Except for American Indian/ Alaska Native (AI/AN) members, HIP member eligibility shall not be final until the first day of the month in which either (i) the POWER Account contribution is paid, or (ii) non-payment is determined for individuals at or below 100% FPL who choose not to participate in HIP Plus. A member’s initial POWER Account contribution is due within sixty (60) calendar days of the date the Contractor receives a member’s conditionally eligible file from the State. The Contractor shall receive conditional eligibility files of individuals that selected, or were auto-auto assigned to, the Contractor’s plan from the State. Within three (3) business days of receiving the conditional eligibility file, the Contractor shall send a Welcome Letter and initial invoice to the individual for their first POWER Account contribution. The first invoice shall reflect the member’s monthly POWER Account contribution as determined by the State. The Welcome Letter shall include a notice explaining that the individual shall submit their initial payment within sixty (60) calendar days in order to receive HIP Plus benefits. The notice shall be tailored to individuals at or below 100% FPL and those above 100% FPL. The Welcome Letter to individuals above 100% FPL shall explain that if the initial payment is not received within sixty (60) calendar days, the member’s coverage will not commence commence, and they will have to reapply for HIP. The Welcome Letter to individuals at or below 100% FPL shall explain that if the initial payment is not received within sixty (60) calendar days, their coverage under HIP Basic will begin on the first day of the month in which the sixty (60) day period ends. The Welcome Letter shall also have a notice prominently displayed on the first page stating in substance that the individual has the right to select another MCE before the first payment is made. Such notice shall include information for how the individual may contact the enrollment broker to change MCEs. As with all member communications, the Welcome Letter shall be reviewed and approved by the State prior to use in accordance with Section 7.1. The Contractor shall provide at least two reminders to individuals who have not made their first monthly POWER Account contribution. Except for AI/AN members, an individual’s enrollment in the Contractor’s plan begins the first day of the month in which the first POWER Account contribution is processed, or after the nonpayment determination has been made for individuals eligible for HIP Basic or HIP State Plan Basic. The Contractor shall process all payments and notify the State of the payment within fifteen (15) calendar days of receiving the payment. The fifteen (15) calendar day period allows time to assure that payments made by check have cleared. Members identified as an AI/AN pursuant to 42 CFR 136.12 are exempt from all cost-cost- sharing, as set forth in Section 4.1.4, and therefore such member’s enrollment in the Contractor’s HIP Plus plan begins the first day of the month in which the member applied to the plan. 4.6.2 Fast Track Enrollment Except for AI/AN members, HIP eligibility shall not be final until either (i) the first day of the month in which the member pays an initial contribution to their POWER Account, or (ii) until the first day of the month in which the initial POWER Account fast track prepayment period expires for individuals at or below 100% FPL who choose not to participate in HIP Plus. For purposes of clarification, a member may enroll in HIP Plus by choosing to pay an initial ten dollar ($10.00) fast track POWER Account prepayment or the member’s first month’s POWER Account contribution in an amount determined by the State. Fast track eligible applicants will be provided the opportunity to pay a ten dollar ($10.00) initial fast track POWER Account prepayment that expedites enrollment into the HIP Plus plan once an individual has been determined eligible by the State. The applicant may pay the fast track prepayment either immediately at the time of application or following receipt of a fast track invoice from the applicant’s MCE. For applicants that select an MCE and elect to pay via credit card at the time of application, the State will connect the applicant directly to the selected MCE’s third party payment partner to collect and process each applicant’s credit card payment. The Contractor shall store the application ID number, payment amount, and payment date at least until the date the Contractor is notified by the State of the applicant’s final eligibility determination. The Contractor shall receive pending eligibility files of individuals that selected, or were auto-assigned to, their plan from the State and meet fast track eligibility criteria. The Contractor shall review all pending eligibility files and identify applicants who have provided payment information to the Contractor via the Indiana Health Coverage Program application. If the Contractor successfully verifies the payment, the Contractor shall send the State notice of payment within one (1) business day of receiving the pending eligibility file. Within two (2) business day of receiving the pending eligibility file of either (i) an applicant who did not pay the fast track payment via credit card on the Indiana Health Coverage Application or (ii) whose credit card information was unable to be successfully verified and/or processed, the Contractor shall send an initial invoice to the individual for a ten dollar ($10.00) POWER Account fast track prepayment. The invoice shall include a notice explaining that the individual has not yet been determined eligible for HIP benefits, but the initial fast track prepayment shall be paid within sixty (60) calendar days in order for the potential member to be eligible to receive HIP Plus benefits. The notice shall encourage prompt payment of the fast track prepayment which could advance the potential member’s benefit start date. Further, the initial invoice shall also include a prominent notice stating in substance that the potential member has the right to select another MCE at any time before the first payment is made. Such notice shall include information for how the potential member may contact the enrollment broker to change MCEs. In addition, the notice shall clearly indicate that the fast track prepayment is an optional payment that either (i) will be fully refunded to the individual in the event the pending applicant is determined by the State not to be eligible for HIP, or (ii) will be applied towards the member’s future required POWER Account contribution(s) in the event the potential member is determined eligible for HIP. The notice shall explain that if the member is determined eligible for HIP, their monthly POWER account contributions may be greater than the initial fast track prepayment, in which case, the member may owe more in the second month in order to continue to receive HIP Plus benefits. As with all member communications, the fast track enrollment notice shall be reviewed and approved by the State prior to use in accordance with Section 7.1. A member’s fast track prepayment or initial POWER Account contribution is due within sixty (60) calendar days of the date the Contractor receives the member’s pending eligibility file from the State. The Contractor shall provide at least two (2) reminders during the sixty (60) day payment period to individuals who have not made their initial fast track prepayment or first monthly POWER Account contribution. The Contractor shall process all payments and notify the State of the payment within fifteen (15) calendar days of receiving the payment. The fifteen (15) calendar day period allows time to assure that payments made by check have cleared. Notwithstanding the foregoing, the Contractor may elect to hold fast track prepayments received from applicants not yet determined eligible by the State until such time the applicant is determined eligible. If the Contractor elects to hold such payments, the Contractor shall verify the payment and notify the State of receipt of a valid payment method within fifteen (15) calendar days of receipt. Once the applicant is determined eligible, the Contractor shall release the hold and process payment no later than fifteen (15) calendar days from the Contractor’s receipt of the eligibility file. A member’s enrollment in the Contractor’s plan begins as follows: i. If the member pays either the fast track prepayment or the initial POWER Account contribution within the original sixty (60) day fast track payment period, the effective date of coverage is the first day of the month in which the member made his or her initial payment. Potential members who pay the fast track prepayment prior to the State’s eligibility determination will be directly opened into HIP Plus benefits upon the State’s final eligibility determination. ii. Members who have an open presumptive eligibility segment and make a fast track payment with their full IHCP application will open into HIP Plus the first day of the month following their fast track payment. iii. If the potential member does not pay the fast track prepayment or their initial POWER Account contribution within the sixty (60) day payment period but is found otherwise eligible for HIP, the potential member will become conditionally eligible for HIP following the eligibility determination, and either: a. the effective date of coverage will be the first day of the month in which the sixty (60) day fast track prepayment period expired for individuals below 100% FPL or who are otherwise exempt from non-payment penalties in accordance with Section 4.7.1; or b. the individual will be determined ineligible and will have to reapply for HIP benefits if the individual is over 100% FPL and is not otherwise exempt from non-payment penalties in accordance with Section 4.7.1. iv. Members identified as an AI/AN pursuant to 42 CFR 136.12 are exempt from all cost-sharing, as set forth in Section 4.1.4, and therefore, unless such member opts of out managed care via the process determined by the State, such member’s enrollment in the Contractor’s HIP Plus or HIP State Plan Plus plan, as applicable, begins the first day of the month in which the individual applied for the plan. As described in subsection (ii) above, a potential member who is determined eligible for HIP by the State before the initial fast track prepayment was received and prior to the expiration of the sixty (60) day fast track payment period, will be considered conditionally eligible. Within three (3) business days of receiving the conditionally eligible file, the Contractor shall send a Welcome Letter to the conditionally eligible member. The Welcome Letter shall be tailored to individuals at or below 100% FPL and those above 100% FPL. a. The Welcome Letter to members above 100% FPL shall explain that if either the initial fast track prepayment or full POWER Account contribution is not received prior to the expiration of the sixty (60) day fast track payment period, the member’s coverage will not commence and they will have to reapply for HIP. b. The Welcome Letter to members at or below 100% FPL shall explain that if either the initial fast track prepayment or full POWER Account contribution is not received prior to the expiration of the sixty (60) day fast track payment period, the member’s coverage under HIP Basic will begin on the first day of the month in which the payment period expires. The Contractor’s Welcome Letter to all conditionally eligible members who have not yet made a fast track prepayment shall include a notice that if the member’s POWER Account contribution is greater than ten dollars ($10.00) the initial fast track prepayment is the minimum required to obtain HIP Plus benefits and start the program, however, the member will remain responsible for the full amount of the POWER Account contribution during the first month of coverage and such amount will be included on the subsequent month POWER Account invoice. The Welcome Letter shall also have a notice prominently displayed on the first page stating in substance that the individual has the right to select another MCE at any time before the first payment is made. Such notice shall include information for how the individual may contact the enrollment broker to change MCEs. As with all member communications, the Welcome Letter shall be reviewed and approved by the State prior to use in accordance with Section 7.1. Due to the fact that the Contractor may collect the initial fast track prepayment before the member’s individual POWER Account contribution has been determined by the State, the Contractor will be required to reconcile any overpayments or underpayments resulting from the fast track prepayment. Specifically, if the member’s POWER Account contribution is less than the fast track prepayment, the Contractor shall credit the fast track prepayment against the member’s required POWER Account contributions on a first month’s basis. For example, for a member with a $1.00 per month contribution, the Contractor shall immediately credit the member’s account and apply the payment to cover the first ten months of required member contributions. By contrast, if the member’s POWER Account contribution is greater than the fast track prepayment, the Contractor shall credit the fast track prepayment to the member’s first month’s required POWER Account contribution and add the remaining balance to the member’s subsequent POWER Account contribution. The member will have sixty (60) calendar days to pay the remaining balance. For individuals who pay their fast track prepayment within the sixty (60) day payment period but who are determined ineligible for HIP, the Contractor shall return any such funds within ten (10) business days of the determination.