Examples of HIP State Plan Basic in a sentence
Notwithstanding the foregoing, the Contractor may elect to provide enhanced benefits and services to HIP Basic and HIP State Plan Basic members, provided that such benefits and services are not applied against the member’s POWER Account.
For members on HIP Basic or HIP State Plan Basic who make copayments instead of POWER Account contributions, the State will fund the entire POWER Account.
Also, prescriptions obtained by a HIP Basic or HIP State Plan Basic member that are not otherwise exempt on the basis of being preventive, family planning, or maternity, are subject to the copayment amounts set forth in Section 4.1.2. Copayments assessed to the HIP Basic or HIP State Plan Basic member at the point of sale may not exceed the total cost of the drug.
If a HIP Basic or HIP State Plan Basic member is eligible for a discount for participation in HIP Plus, the Contractor shall notify the member of the opportunity to transfer to HIP Plus benefits or HIP State Plan Plus at the discounted rate.
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.
Members enrolled in HIP Basic or HIP State Plan Basic are not required to make monthly contributions to their POWER Account, but are required to pay the following copayments at the time services are rendered: No copayment is required for preventative care, maternity services or family planning services.
Notwithstanding t he foregoing, the Contractor may elect to provide enhanced benefits and services to HIP Basic and HIP State Plan Basic members, provided that such benefits and services are not applied against the member’s POWER Account.
Provider claims for HIP Basic and HIP State Plan Basic members will be paid less the member copayment amount and providers are contractually obligated to not charge members more than the required copayment for HIP Basic.
This section should not be interpreted as interfering with a provider’s ability to hold HIP members liable for the emergency services co-payment or HIP Basic or HIP State Plan Basic member liability for allowable copayment amounts set forth in Section 4.1.2. Further, this section should not be interpreted as preventing payment of covered services with POWER Account funds before the member’s deductible has been met.
Notwithstanding the foregoing, individuals eligible for HIP with income at or below one-hundred percent (100%) of the federal poverty level (FPL) who do not make a fast-track pre-payment or initial POWER Account contribution within the sixty (60) calendar day due date in accordance with Section 4.7 of the Scope of Work will be enrolled in the HIP Basic or HIP State Plan Basic benefits effective the first day of the month in which non-payment was determined.