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

Non-Payment of Monthly POWER Account Contribution. If an enrollee does not make a required monthly contribution within 60 days of its due date, the enrollee will be terminated from participation in HIP and disenrolled from the MCO or ESP. The enrollee will also forfeit 25 percent of the enrollee’s pro rata share of funds remaining in the POWER account. a. Before terminating the enrollee, the MCO or ESP must provide at least one written notice advising the enrollee of the delinquent payment, and the date by which the contribution must be paid to prevent disenrollment, as well as notice of the enrollee’s appeal rights. The notice must be sent to the enrollee on or before the seventh day of delinquency and must state that the enrollee will be disenrolled from the MCO or ESP and terminated from participation in HIP if payment is not received prior to the date specified in the notice. The notice must explain that if the enrollee is terminated from participation in HIP, the enrollee will not be able to reapply for HIP coverage for a period of at least 12 months. b. The MCO or ESP is required to refund the enrollee’s pro rata portion of the POWER Account, which must be distributed to the enrollee no later than sixty (60) days after the last date of participation in the MCO or ESP. The amount payable to the enrollee shall be determined as follows: i. Calculate the total enrollee contribution to the POWER Account for the coverage term, including all enrollee balances carried forward from prior coverage terms (ET); ii. Calculate the amount actually contributed by the enrollee to the POWER Account for the coverage term, including all enrollee balances carried forward from prior coverage terms (EA); iii. Calculate the percentage of the POWER Account expended during the coverage term, which will equal the total dollar amount expended, divided by $1,100 (u); iv. Multiply the result in (iii) by the result in (i), and subtract from the result in (ii) (R = EA – u*ET). v. If the result in (iv) is positive, the MCO or ESP must return 75 percent of this amount to the enrollee and 25 percent of this amount to the state. vi. If the result in (iv) is negative, the result is the amount that the enrollee owes to the MCO or ESP as described in paragraphs 38 (b) through 38(d). vii. The MCO or ESP must return to the state all unexpended state POWER Account contributions, including amounts carried forward from prior coverage terms.

Non-Payment of Monthly POWER Account Contribution. If an enrollee does not make a required monthly contribution within 60 days of its due date, the enrollee will be terminated from participation in HIP and disenrolled from the MCO or ESP. The enrollee will also forfeit 25 percent of the enrollee’s pro rata share of funds remaining in the POWER account. a. Before terminating the enrollee, the MCO or ESP must provide at least one written notice advising the enrollee of the delinquent payment, and the date by which the contribution must be paid to prevent disenrollment, as well as notice of the enrollee’s appeal rights. The notice must be sent to the enrollee on or before the seventh day of delinquency and must state that the enrollee will be disenrolled from the MCO or ESP and terminated from participation in HIP if payment is not received prior to the date specified in the notice. The notice must explain that if the enrollee is terminated from participation in HIP, the enrollee will not be able to reapply for HIP coverage for a period of at least 12 months. b. The MCO or ESP is required to refund the enrollee’s pro rata portion of the POWER Account, which must be distributed to the enrollee no later than sixty (60) days after the last date of participation in the MCO or ESP. The amount payable to the enrollee shall be determined as follows: i. Calculate the total enrollee contribution to the POWER Account for the coverage term, including all enrollee balances carried forward from prior coverage terms (ET); ii. Calculate the amount actually contributed by the enrollee to the POWER Account for the coverage term, including all enrollee balances carried forward from prior coverage terms (EA); iii. Calculate the percentage of the POWER Account expended during the coverage term, which will equal the total dollar amount expended, divided by $1,100 (u); iv. Multiply the result in (iii) by the result in (i), and subtract from the result in (ii) (R = EA – u*ET). v. If the result in (iv) is positive, the MCO or ESP must return 75 percent of this amount to the enrollee and 25 percent of this amount to the stateState. vi. If the result in (iv) is negative, the result is the amount that the enrollee owes to the MCO or ESP as described in paragraphs 38 (b43(b) through 38(d43(d). vii. The MCO or ESP must return to the state State all unexpended state State POWER Account contributions, including amounts carried forward from prior coverage terms.

Non-Payment of Monthly POWER Account Contribution. If an enrollee does not make a required monthly contribution within 60 days of its due date, the enrollee will be terminated from participation in HIP and disenrolled from the MCO or ESPMCO. The enrollee will also forfeit 25 percent of the enrollee’s pro rata share of funds remaining in the POWER account. a. Before terminating the enrollee, the MCO or ESP must provide at least one written notice advising the enrollee of the delinquent payment, and the date by which the contribution must be paid to prevent disenrollment, as well as notice of the enrollee’s appeal rights. The notice must be sent to the enrollee on or before the seventh day of delinquency and must state that the enrollee will be disenrolled from the MCO or ESP and terminated from participation in HIP if payment is not received prior to the date specified in the notice. The notice must explain that if the enrollee is terminated from participation in HIP, the enrollee will not be able to reapply for HIP coverage for a period of at least 12 months. b. The MCO or ESP is required to refund the enrollee’s pro rata portion of the POWER Account, which must be distributed to the enrollee no later than sixty (60) days after the last date of participation in the MCO or ESPMCO. The amount payable to the enrollee shall be determined as follows: i. Calculate the total enrollee contribution to the POWER Account for the coverage term, including all enrollee balances carried forward from prior coverage terms (ET); ii. Calculate the amount actually contributed by the enrollee to the POWER Account for the coverage term, including all enrollee balances carried forward from prior coverage terms (EA); iii. Calculate the percentage of the POWER Account expended during the coverage term, which will equal the total dollar amount expended, divided by $1,100 (u); iv. Multiply the result in (iii) by the result in (i), and subtract from the result in (ii) (R = EA – u*ET). v. If the result in (iv) is positive, the MCO or ESP must return 75 percent of this amount to the enrollee and 25 percent of this amount to the state. vi. If the result in (iv) is negative, the result is the amount that the enrollee owes to the MCO or ESP as described in paragraphs 38 paragraph 37 (b) through 38(d37 (d). vii. The MCO or ESP must return to the state all unexpended state POWER Account contributions, including amounts carried forward from prior coverage terms.