Section 405IAC10-10-3. POWER account contributions; copayments

   (a) A member enrolled in either HIP Plus or HIP State Plan Plus shall be required to contribute a monthly amount to the member's POWER account. Except as provided in subsection (g), a member's monthly POWER account contribution shall be determined by multiplying a member's annual household income by two percent (2%) and dividing by twelve (12). In no event shall the member's monthly POWER account payment exceed one hundred dollars ($100) per month or be less than one dollar ($1) per month.

  (b) Except as provided under subsection (c), a member enrolled in HIP Basic or HIP State Plan Basic shall not be required to make monthly contributions to the member's POWER account but shall be charged a copayment at the time services are rendered, as follows:

(1) Four dollars ($4) for outpatient services.

(2) Seventy-five dollars ($75) for inpatient services.

(3) Four dollars ($4) for preferred drugs.

(4) Eight dollars ($8) for nonpreferred drugs.

  (c) The following members shall not be subject to cost sharing under this section:

(1) An American Indian/Alaskan Native.

(2) A pregnant woman.

(3) Any individual who meets the requirements in subsection (f).

  (d) No copayment shall be required for the following services:

(1) Preventive care services.

(2) Family planning services.

(3) Maternity services.

  (e) A provider shall be responsible for collecting the required copayments at the time services are provided. A provider may not deny a service to a member if such member is unable to pay the copayment at the time of service delivery. If a member does not pay the copayment at the time services are provided, the member shall still be responsible for paying the copayment and the provider may bill the member for the copayment amount owed.

  (f) A member's out-of-pocket cost sharing amount shall not exceed five percent (5%) of the member's annual household income, except that all HIP Plus or HIP State Plan Plus members whose household income is at or below five percent (5%) of the FPL shall be required to contribute, at a minimum, monthly one dollar ($1) POWER account contributions.

  (g) In a family with two (2) or more members, each member shall have a POWER account established in accordance with section 1 of this rule. In the case where two (2) members are married, the combined total of both spouses' required POWER account contributions cannot exceed two percent (2%) of the monthly household income, subject to the one dollar ($1) minimum contribution amount set forth in subsection (f). (Office of the Secretary of Family and Social Services; 405 IAC 10-10-3; filed May 18, 2015, 12:34 p.m.: 20150617-IR-405140339FRA)