Common use of Individual Cost-Sharing Obligations Clause in Contracts

Individual Cost-Sharing Obligations. As detailed in Section 6.16, the Contractor shall ensure that member cost sharing as set forth in this Section 4.1 does not exceed 5% of family income as calculated on a quarterly basis, except that all HIP Plus or HIP State Plan Plus members whose household income is at or below five percent (5%) of the FPL will be required to contribute, at a minimum, monthly one dollar ($1.00) POWER account contributions. The Contractor will work with the State to consider all contributions made by the household in the calculation and monitoring of the 5% contribution limit. The Contractor will have the ability to identify members who have reached the maximum contribution and to cease that member’s cost sharing obligations in accordance with the HIP MCE Policies and Procedure Manual. While the Contractor has the primary responsibility for tracking member’s cost sharing, the Contractor shall also have a process in place that allows a member to self-report on their expenditures and have a process in place to end cost sharing based on member provided documentation. In addition to the cost-sharing set forth below, all HIP members (with the exception of members exempt from cost-sharing as described in Section 4.1.4) will be required to make an $8.00 copayment for non-emergent use of hospital emergency departments, as further described in Section 6.6.2.

Individual Cost-Sharing Obligations. As detailed in Section 6.16, the Contractor shall ensure that member cost sharing as set forth in this Section 4.1 does not exceed 5% of family income as calculated on a quarterly basis, except that all HIP Plus or HIP State Plan Plus members whose household income is at or below five percent (5%) of the FPL will be required to contribute, at a minimum, monthly one dollar ($1.00) POWER account contributions. The Contractor will work with the State to consider all contributions made by the household in the calculation and monitoring of the 5% contribution limit. The Contractor will have the ability to identify members who have reached the maximum contribution and to cease that member’s cost sharing obligations in accordance with the HIP MCE Policies and Procedure Manual. While the Contractor has the primary responsibility for tracking member’s cost sharing, the Contractor shall they should also have a process in place that allows a member to self-report on their expenditures and have a process in place to end cost sharing based on member provided documentation. In addition to the cost-sharing set forth below, all HIP members (with the exception of members exempt from cost-sharing as described in Section 4.1.4) will be required to make an $8.00 copayment copayments for non-emergent use of hospital emergency departments, as further described in Section 6.6.2.