Section 405IAC10-10-5. Annual recalculation of POWER account contribution; rollover; copayment

   (a) For a member who remains eligible for the plan at the end of the benefit period, the state shall recalculate such member's POWER account contribution as part of the renewal process. This may occur after the new benefit period has begun. POWER account contributions recalculated pursuant to this section shall be effective the first day of the month following the recalculation.

  (b) A member enrolled in HIP Plus or HIP State Plan Plus with a balance remaining in the member's POWER account at the end of the benefit period may be eligible to roll over a portion of the account balance to reduce such member's POWER account contributions for the new benefit period in accordance with subsection (c) or (d), as applicable.

  (c) If a member enrolled in HIP Plus or HIP State Plan Plus has met the member's preventive care services goals as set by the office for the expiring benefit period as set forth in 405 IAC 10-7-8, the member's final rollover amount shall be calculated as follows:

(1) The member's portion is determined by adding the member's required annual contribution for the expiring benefit period to any balance rolled over from previous benefit periods and dividing that sum by two thousand five hundred dollars ($2,500).

(2) The base rollover amount is determined by multiplying the member's portion as determined in subdivision (1) by any remaining balance in the POWER account.

(3) The final rollover amount is determined by multiplying the base rollover amount as determined in subdivision (2) by two (2).

  (d) If a member enrolled in HIP Plus or HIP State Plan Plus has not met the member's preventive care services goals as set by the office for the expiring benefit period as set forth in 405 IAC 10-7-8, the member's final rollover amount shall be calculated only in accordance with subsection (c)(1) and (c)(2). Such member's base rollover amount shall not be multiplied by two (2).

  (e) A HIP Basic or HIP State Plan Basic member with a POWER account balance remaining at the end of the expiring benefit period shall be eligible to receive a discount on the POWER account contribution such member would need to make in order to be enrolled in the HIP Plus or HIP State Plan Plus plan for the new benefit period. The HIP Plus discount for a HIP Basic or HIP State Plan Basic member with a POWER account balance shall be calculated as follows:

(1) Divide the remaining balance in the POWER account by two thousand five hundred dollars ($2,500). If the resulting percentage is less than or equal to fifty percent (50%), then that percentage shall be used in subdivision (2). However, if the resulting percentage is greater than fifty percent (50%), then the percentage shall be capped at fifty percent (50%) for purposes of subdivision (2).

(2) Multiply the required POWER account contribution for the current benefit period by the percentage calculated in subdivision (1).

(3) Subtract the product calculated in subdivision (2) from the POWER account contribution for the current benefit period.

  (f) The insurers may collect member debt, if any, as calculated under section 7 of this rule, from the member portion of rollover funds calculated in either subsection (c), (d), or (e). The resulting amount shall reduce the member's annual POWER account contribution for the new benefit period. No rollover funds contributed by the state may be used to pay member debt.

  (g) The insurer shall reconcile a member's POWER account for the rollover process described in this section no later than one hundred twenty (120) days after the end of the benefit period. A member who remains enrolled in HIP Basic or HIP State Plan Basic at the time the member receives notice of the amount of the discount set forth in subsection (e) shall have a period of sixty (60) days from the date of such notice to transfer to HIP Plus or HIP State Plan Plus by making a POWER account contribution at the new discounted rate.

  (h) In the event the amount of the member's POWER account balance that is rolled over at the end of the benefit period exceeds the amount of the member's annual POWER account contribution for the new benefit period, the member shall not receive a refund of the excess amount. The excess funds shall be returned to the office. (Office of the Secretary of Family and Social Services; 405 IAC 10-10-5; filed May 18, 2015, 12:34 p.m.: 20150617-IR-405140339FRA)