Section 405IAC10-10-7. Member debt

   (a) For purposes of this section, "debt" means amounts that accrue as a result of:

(1) an insurer's advance payment of the member's portion of the deductible as provided under 405 IAC 10-9-5(a)(1) that has not been repaid through the member's POWER account contributions; or

(2) any nonsufficient funds check charges resulting from a member's payments to an insurer as a result of payment processing.

  (b) A member's debt under subsection (a)(1) shall be calculated as follows:

(1) Divide the member's annual POWER account contribution amount by two thousand five hundred dollars ($2,500).

(2) Multiply the amount of claims paid up to two thousand five hundred dollars ($2,500) during the benefit period by the amount determined in subdivision (1).

(3) Subtract the total monthly individual contributions paid by the member during the benefit period by the amount determined under subdivision (2).

  (c) A member's debt under this section shall not exceed the following amounts:

(1) For a member with household income above one hundred percent (100%) of the FPL, an amount that does not exceed ten percent (10%) of the cost of services received.

(2) For a member with household income at or below one hundred percent (100%) of the FPL, an amount that does not exceed the sum of the unpaid monthly contributions as determined in accordance with section 3(a) of this rule that accrued during the months in which the member received HIP Plus coverage.

  (d) In some cases, the two thousand five hundred dollar ($2,500) deductible will be met before a HIP Plus or HIP State Plan Plus member has made all of the member's required contributions. The fact that a member has not yet made all required POWER account contributions does not relieve the insurer of the responsibility to pay providers for covered services rendered. An insurer may deduct amounts a member owes from future POWER account contributions.

  (e) If a member ends participation in the plan before the conclusion of the member's twelve (12) month benefit period and the individual has debt, the insurer may collect from the individual. (Office of the Secretary of Family and Social Services; 405 IAC 10-10-7; filed May 18, 2015, 12:34 p.m.: 20150617-IR-405140339FRA)