Regulation .10-1 Low-Income Subsidy.
Regulation .10-1 Low-Income Subsidy.LinkCopy Citation
A.
The Board may subsidize the premiums, deductibles, and other expenses of an individual based on the individual's income if the individual:
(1)
Is enrolled, or eligible to enroll, in the Plan;
(2)
Has an annual household income that is at or below a percentage of the federal poverty level established by the Board;
(3)
Submits to the plan administrator an application for the low-income subsidy on the form required by the Board; and
(4)
Provides to the plan administrator verification of annual household income in a form acceptable to the Board.
B.
Initial Application.
(1)
An individual may apply for a low-income subsidy at any time.
(2)
If an applicant for a low-income subsidy fails to provide all of the required documentation, the plan administrator shall notify the applicant of:
(a)
The additional documentation that is required; and
(b)
The deadline set by the plan administrator for receipt of the additional documentation.
(3)
If the applicant fails to provide the additional documentation by the deadline:
(a)
The plan administrator shall notify the applicant that the applicant has not demonstrated eligibility for the low-income subsidy and bill the applicant for standard Plan enrollment; and
(b)
The applicant shall reapply for a low-income subsidy if the applicant wishes to receive future consideration for a low-income subsidy.
C.
Recertification.
(1)
Each year, the plan administrator shall mail a low-income subsidy recertification form to each member currently receiving a low-income subsidy.
(2)
The form shall require the member to provide to the plan administrator updated verification of annual household income:
(a)
In a form acceptable to the Board; and
(b)
That demonstrates continued eligibility for the low-income subsidy.
(3)
If a member who is receiving a low-income subsidy fails to demonstrate continued eligibility for the low-income subsidy, the member may select a standard Plan design option during open enrollment.
(4)
If a member who fails to demonstrate continued eligibility for the low-income subsidy fails to select a standard Plan design option during open enrollment, the plan administrator shall place the member in a Plan design option in accordance with standards established by the Board.
D.
Enrollment Capacity.
(1)
The Board shall determine the number of members who may receive the low-income subsidy each year.
(2)
If the Board determines that the maximum number of members are receiving the low-income subsidy for a year, the plan administrator shall:
(a)
Discontinue granting the low-income subsidy; and
(b)
Establish a waiting list of individuals who are eligible for the low-income subsidy.
(3)
An individual on the waiting list may enroll in a standard Plan design option until a low-income subsidy becomes available to the individual.
E.
Fraud.
(1)
The plan administrator immediately shall cease the low-income subsidy to a member if the plan administrator determines that the member received the low-income subsidy based on fraudulent documentation or statements, including any material misrepresentation but for which the member would not have received the low-income subsidy.
(2)
The Plan may recover from any member or former member the amount of any low-income subsidy that the member or former member received due to the Plan's reliance on a material misrepresentation by the member or former member.