Uniform Premiums and Low Income Subsidy Sample Clauses

Uniform Premiums and Low Income Subsidy. Contract Holder shall comply with the following conditions with respect to any subsidization of that portion of Premiums paid by Contract Holder for the Medicare Prescription Drug benefit (“MA-PD Premium”) and any required MA-PD Premium contribution by the Member: • Contract Holder may subsidize different amounts of MA-PD Premium for different classes of Members and their dependents, provided such classes are reasonable and based on objective business criteria, such as years of service, business location, job category, and nature of compensation (e.g., salaried vs. hourly). Classes of Members and their dependents cannot be based on eligibility for the Low Income Subsidy (“LIS”) provided by CMS for certain individuals. • MA-PD Premium contribution levels cannot vary for Members within a given class. • Direct subsidy payments from CMS to Aetna must be passed through to reduce the amount of any required MA-PD Premium payment by the Member (“Member Contribution”) so the Member in no event shall be required to pay more than the sum of: a) the standard Medicare Part D premium, net of the direct subsidy payment from CMS, and b) one hundred percent (100%) for any supplemental coverage selected by the Member. Contract Holder shall comply with the following conditions with respect to any LIS payment received from CMS for any LIS-eligible Member: • Any monthly LIS payment received from CMS for an LIS-eligible Member shall be used to reduce any Member Contribution. Any remainder may then be used to reduce the amount of the Contract Holder’s MA-PD Premium contribution. • If the LIS payment for any LIS-eligible Member is less than the Member Contribution required by such individual (including the Member Contribution for supplemental benefits, if any), Contract Holder shall communicate with the LIS- eligible Member about the cost of remaining enrolled in Contract Holder’s plan versus obtaining coverage as an individual under another Medicare Part D Prescription Drug plan.
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Related to Uniform Premiums and Low Income Subsidy

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