Section 405IAC10-4-11. Presumptive eligibility

   (a) An individual may apply for presumptive eligibility under the plan. A qualified presumptive eligibility provider shall determine whether an individual is eligible for a presumptive eligibility period.

  (b) An individual who is determined presumptively eligible for the plan shall be enrolled with an insurer and be provided benefits equivalent to HIP Basic, including applicable copayments as set forth in 405 IAC 10-10-3(b).

  (c) A presumptively eligible individual who does not file an Indiana application for health coverage shall receive the presumptive eligibility benefits described in subsection (b) until the last day of the month following the month in which the determination of presumptive eligibility was made.

  (d) A presumptively eligible individual whose application for health coverage has been filed and approved by the division shall receive the presumptive eligibility benefits described in subsection (b), until one (1) of the following occurs, as applicable:

(1) For a presumptively eligible individual who has paid an initial fast track prepayment or a POWER account contribution within sixty (60) days of the date of the invoice, in accordance with 405 IAC 10-3-2 or 405 IAC 10-3-3, the presumptive eligibility period shall end effective the first day of the month following the month in which the payment was made or the eligibility determination was made, whichever is later, and such individual shall begin HIP Plus or HIP State Plan Plus benefits, as applicable, effective the first day of the month following the month in which the payment was made or the eligibility determination was made, whichever is later, with no gap in coverage.

(2) For a presumptively eligible individual with household income greater than one hundred percent (100%) of the FPL, who is not otherwise eligible to receive HIP Basic benefits, and who has not paid an initial fast track prepayment or a POWER account contribution within sixty (60) days of the date of the invoice, in accordance with 405 IAC 10-3-2 or 405 IAC 10-3-3, the presumptive eligibility period shall end effective the date in which the office determines nonpayment.

(3) For a presumptively eligible individual with household income below one hundred percent (100%) of the FPL who has not paid an initial fast track prepayment or a POWER account contribution within sixty (60) days of the date of the invoice, in accordance with 405 IAC 10-3-2 or 405 IAC 10-3-3, the presumptive eligibility period shall end effective the first day of the month following the month in which the sixty (60) day payment period expired, and such individual shall begin HIP Basic or HIP State Plan Basic benefits, as applicable, effective the first day of the month following the month in which the sixty (60) day payment period expired, with no gap in coverage.

  (e) A presumptively eligible individual whose Indiana application for health coverage has been filed, but not approved by the division, shall receive the presumptive eligibility benefits described in subsection (b), until the day on which a decision is made on that application.

  (f) An individual whose presumptive eligibility period ends in accordance with subsections (c), (d)(2), and (e) shall not be enrolled in the plan and may reapply.

  (g) An individual shall only be approved for one (1) period of presumptive eligibility within a twelve (12) month period beginning on the date that a qualified presumptive eligibility provider makes an affirmative presumptive eligibility determination. (Office of the Secretary of Family and Social Services; 405 IAC 10-4-11; filed May 18, 2015, 12:34 p.m.: 20150617-IR-405140339FRA)