Common use of Non-Payment of Monthly POWER Account Contribution Clause in Contracts

Non-Payment of Monthly POWER Account Contribution. Other than the exceptions listed in Section 4.7.1, HIP members who do not make a required POWER Account contribution within sixty (60) calendar days of its due date or an initial fast track prepayment prior to the expiration of the sixty (60) calendar day fast track period will either be (i) terminated from the program and disenrolled from the Contractor’s plan if the member has income greater than 100% FPL, or (ii) transferred to HIP Basic benefits if the member has income equal to or less than 100% FPL or are otherwise exempt from non-payment penalties, in accordance with Section 4.7.1. Notwithstanding the foregoing, upon non-payment, members receiving HIP State Plan benefits who either have income equal to or less than 100% FPL or are otherwise exempt from non-payment penalties as set forth in Section 4.7.1 will be required to make co-payments consistent with Section 4.1.2, but will not be subject to a change in benefits. Payment via a dishonored check due to non-sufficient funds (NSF) will be considered non- payment, and members who have made such a payment will be terminated from the program or transferred to HIP Basic, as applicable, if they are unable to provide the full amount that is in delinquency within sixty (60) calendar days of its original due date. If a member’s check is returned for non-sufficient funds, the Contractor may charge a reasonable fee for the returned check. The Contractor shall develop, print and mail notices to members if their payments are returned from the bank due to non-sufficient funds. The Contractor shall notify the State, through CoreMMIS, when a member does not pay their initial fast track prepayment by its due date, or their POWER Account contribution within sixty (60) calendar days of its due date. Upon the expiration of the payment due date, if no payment has been received, the Contractor shall send notification to the State electronically in accordance with the HIP MCE Policies and Procedure manual no later than three (3) business days from the expiration of the payment due date. The Contractor shall wait until either a termination record is

Non-Payment of Monthly POWER Account Contribution. Other than the exceptions listed in Section 4.7.1, HIP members who do not make a required POWER Account contribution within sixty (60) calendar days of its due date or an initial fast track prepayment prior to the expiration of the sixty (60) calendar day fast track period will either be (i) terminated from the program and disenrolled from the Contractor’s plan if the member has income greater than 100% FPL, or (ii) transferred to HIP Basic benefits if the member has income equal to or less than 100% FPL or are otherwise exempt from non-payment penalties, in accordance with Section 4.7.1. Notwithstanding the foregoing, upon non-payment, members receiving HIP State Plan benefits who either have income equal to or less than 100% FPL or are otherwise exempt from non-payment penalties as set forth in Section 4.7.1 will be required to make co-payments consistent with Section 4.1.2, but will not be subject to a change in benefits. Payment via a dishonored check due to non-sufficient funds (NSF) will be considered non- payment, and members who have made such a payment will be terminated from the program or transferred to HIP Basic, as applicable, if they are unable to provide the full amount that is in delinquency within sixty (60) calendar days of its original due date. If a member’s check is returned for non-sufficient funds, the Contractor may charge a reasonable fee for the returned check. The Contractor shall develop, print and mail notices to members if their payments are returned from the bank due to non-sufficient funds. The Contractor shall notify the State, through CoreMMIS, when a member does not pay their initial fast track prepayment by its due date, or their POWER Account contribution within sixty (60) calendar days of its due date. Upon the expiration of the payment due date, if no payment has been received, the Contractor shall send notification to the State electronically in accordance with the HIP MCE Policies and Procedure manual no later than three (3) business days from the expiration of the payment due date. The Contractor shall wait until either a termination record isis received from the State to terminate a fully enrolled member from the plan, or until other notice is received from the State indicating a change in benefits to HIP Basic.

Non-Payment of Monthly POWER Account Contribution. Other than the exceptions listed in Section 4.7.1, HIP members who do not make a required POWER Account contribution within sixty (60) calendar days of its due date or an initial fast track prepayment prior to the expiration of the sixty (60) calendar day fast track period will either be (i) terminated from the program and disenrolled from the Contractor’s plan if the member has income greater than 100% FPL, or (ii) transferred to HIP Basic benefits if the member has income equal to or less than 100% FPL or are otherwise exempt from non-payment penalties, in accordance with Section 4.7.1. Notwithstanding the foregoing, upon non-payment, members receiving HIP State Plan benefits who either have income equal to or less than 100% FPL or are otherwise exempt from non-payment penalties as set forth in Section 4.7.1 will be required to make co-payments consistent with Section 4.1.2, but will not be subject to a change in benefits. Payment via a dishonored check due to non-sufficient funds (NSF) will be considered non- payment, and members who have made such a payment will be terminated from the program or transferred to HIP Basic, as applicable, if they are unable to provide the full amount that is in delinquency within sixty (60) calendar days of its original due date. If a member’s check is returned for non-sufficient funds, the Contractor may charge a reasonable fee for the returned check. The Contractor shall develop, print and mail notices to members if their payments are returned from the bank due to non-sufficient funds. The Contractor shall notify the State, through CoreMMIS, when a member does not pay their initial fast track prepayment by its due date, or their POWER Account contribution within sixty (60) calendar days of its due date. Upon the expiration of the payment due date, if no payment has been received, the Contractor shall send notification to the State electronically in accordance with the HIP MCE Policies and Procedure manual no later than three (3) business days from the expiration of the payment due date. The Contractor shall wait until either a termination record isis received from the State to terminate a fully enrolled member from the plan, or until other notice is received from the State indicating a change in benefits to HIP Basic. 4.7.1 Non-Payment Penalty Exceptions

Non-Payment of Monthly POWER Account Contribution. Other than the exceptions listed in Section 4.7.1, HIP members who do not make a required POWER Account contribution within sixty (60) calendar days of its due date or an initial fast track prepayment prior to the expiration of the sixty (60) calendar day fast track period will either be (i) terminated from the program and shall be disenrolled from the Contractor’s plan if the member has they have income greater than 100% FPL, or (ii) transferred to HIP Basic benefits if the member has they have income equal to or less than 100% FPL or are otherwise exempt from non-payment penalties, in accordance with Section 4.7.1. Notwithstanding the foregoing, upon non-payment, members receiving HIP State Plan benefits who either have income equal to or less than 100% FPL or are otherwise exempt from non-payment penalties as set forth in Section 4.7.1 will be required to make co-payments consistent with Section 4.1.2, but will not be subject to a change in benefits. Payment via a dishonored check due to non-sufficient funds (NSF) will be considered non- payment, and members who have made such a payment will be terminated from the program or transferred to HIP Basic, as applicable, if they are unable to provide the full amount that is in delinquency within sixty (60) calendar days of its original due date. If a member’s check is returned for non-sufficient funds, the Contractor may charge a reasonable fee for the returned check. The Contractor shall develop, print and mail notices to members if their payments are returned from the bank due to non-sufficient funds. The Contractor shall notify the State, through CoreMMISthe Indiana Client Eligibility System (ICES), when a member does not pay their initial fast track prepayment by its due date, or their POWER Account contribution within sixty (60) calendar days of its due date. Upon the expiration of the payment due date, if no payment has been received, the Contractor shall send notification to the State electronically in accordance with the HIP MCE Policies and Procedure manual no later than three (3) business days from the expiration of the payment due date. The Contractor shall wait until either a termination record isis received from the State to terminate a fully enrolled member from the plan, or until other notice is received from the State indicating a change in benefits to HIP Basic. If a member is disenrolled from HIP for non-payment, the Contractor shall disable the member’s POWER Account debit card immediately. 4.7.1 Non-Payment Penalty Exceptions 4.7.1.1 Disenrollment Exceptions i. 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 annual redetermination in accordance with Section 5.6. ii. Members receiving transitional medical assistance (TMA) as set forth in Section 3.3.1 who do not make their POWER Account contributions will not be subject to termination for non-payment, but rather such members will be transferred to the HIP State Plan Basic regardless of FPL during their guaranteed TMA eligibility period. 4.7.1.2 Lock-Out Exemption A member who has been terminated for non-payment in accordance with Section 4.7 may be reinstated to the program prior to the expiration of the six month lock out period, if evidence is provided, along with a new application, that the individual either: i. Was a victim of domestic violence at the time the member was terminated for non-payment; ii. Was residing in a county subject to a disaster declaration made in accordance with IC 10-14-3-12 at the time the member was terminated for non-payment or at any time in the sixty (60) calendar days prior to date of member termination for non-payment; iii. Became medically frail; iv. Moved out of state after a missed payment; v. Obtained private insurance any time after a missed payment; or vi. Had an unreported change in income that would have otherwise disqualified the individual from eligibility.