Section 405IAC10-11-7. Member transfers and disenrollment

   (a) A HIP Link member may only make changes to HIP Link enrollment during any of the following:

(1) The initial eligibility determination.

(2) The HIP Link member's redetermination period.

(3) The employer's open enrollment period.

(4) Upon the occurrence of a qualifying event described in subsection (b).

  (b) Upon the occurrence of a qualifying event, a HIP Link member may be subject to transfer in accordance with subsection (c) to HIP Plus during the member's HIP Link benefit period described under section 5(a) of this rule. Such member shall be subject to the HIP enrollment requirements under 405 IAC 10-4-2. For purposes of this rule, a qualifying event includes any of the following:

(1) The employer or ESI plan is determined to no longer meet the eligibility requirements under section 10 of this rule.

(2) The HIP Link member no longer meets the eligibility criteria under section 3 of this rule but remains eligible for HIP under 405 IAC 10-4-1.

(3) The employer withdraws from participation in the program.

(4) The HIP Link member becomes pregnant.

(5) The HIP Link member attests to being medically frail under section 5(h) of this rule.

(6) The HIP Link member meets the definition of Section 1931 parent and caretaker relative under 405 IAC 10-2-1(46).

(7) The HIP Link member meets the definition of transitional medical assistance under 405 IAC 10-2-1(48).

(8) The HIP Link member exhausts the member's POWER account and the member's out-of-pocket contributions reach or exceed five percent (5%) as described under section 5(i) of this rule.

  (c) A transfer to HIP Plus under this section shall be as follows:

(1) A HIP Link member shall be transferred to HIP Plus upon the occurrence of any qualifying event listed under subsection (b)(1) through (b)(3).

(2) A HIP Link member may elect to transfer to HIP Plus upon the occurrence of any qualifying event listed under subsection (b)(4) through (b)(7).

(3) If a HIP Link member meets a qualifying event listed in subsection (b)(8), the office may consider one (1) or more of the following conditions when determining whether the HIP Link member may remain in HIP Link:

(A) The period of time remaining in the HIP Link member's benefit period.

(B) The HIP Link member's medical claims history.

(C) The potential financial impact to the state of transferring the HIP Link member to HIP Plus.

(D) Any other conditions the office determines to be relevant to the specific HIP Link member.

A member who remains in HIP Link under this subsection shall continue to be eligible for HIP Link coverage under this rule.

  (d) A HIP Link member who becomes pregnant may elect coverage as follows:

(1) If such member is not at her redetermination period described in section 6 of this rule, she may:

(A) transfer to Medicaid for pregnant women;

(B) transfer to HIP; or

(C) remain enrolled in HIP Link.

(2) If such member is pregnant at her redetermination period, she may:

(A) remain enrolled in HIP Link; or

(B) transfer to Medicaid for pregnant women.

  (e) A HIP Link member who no longer meets the eligibility requirements for HIP under 405 IAC 10-4-1 shall be disenrolled from HIP Link.

  (f) A HIP Link member who voluntarily disenrolls from HIP Link outside of the circumstances outlined in section 7(a) of this rule shall be disenrolled from HIP Link and not be allowed to reenroll in HIP Link or HIP for six (6) months from the date of disenrollment, subject to the exceptions listed under section 6(b) of this rule. (Office of the Secretary of Family and Social Services; 405 IAC 10-11-7; filed Apr 6, 2016, 11:20 a.m.: 20160504-IR-405150325FRA)