Section 405IAC10-4-6. Pregnant women

   (a) A member who becomes pregnant during the member's benefit period shall remain enrolled in the plan unless the member:

(1) elects to transfer to the pregnant women Medicaid category; or

(2) is pregnant at annual renewal, at which time the member shall be transferred to the pregnant women Medicaid category.

  (b) A pregnant member who remains in the plan as described in subsection (a) shall be exempt from cost sharing, including, but not limited to, the following:

(1) HIP Plus monthly contributions set forth in 405 IAC 10-10-3(a).

(2) HIP Basic copayments set forth in 405 IAC 10-10-3(b).

(3) Copayments for nonemergent use of a hospital emergency department set forth in 405 IAC 10-7-9.

(4) Deductible amounts funded through the member's POWER account.

  (c) A pregnant member who remains in the plan as described in subsection (a) shall receive enhanced benefits as set forth in the state alternative benefit plans for HIP Plus and HIP Basic members throughout the member's pregnancy and for a postpartum period equal to sixty (60) days commencing on the date such individual's pregnancy ends.

  (d) An applicant who:

(1) is pregnant at the time of application; and

(2) otherwise meets the HIP eligibility criteria set forth in section 1 of this rule;

shall not be eligible for the plan, but shall be placed in and receive coverage under the pregnant women Medicaid category.

  (e) A pregnant woman who either is:

(1) transferred to the pregnant women Medicaid category under subsection (a); or

(2) placed in the pregnant women Medicaid category under subsection (d);

shall receive at least sixty (60) days of Medicaid for pregnant women postpartum coverage commencing on the date such individual's pregnancy ends and ending on the first day of the month following the expiration of the sixty (60) day postpartum period.

  (f) This subsection applies to a woman described in subsection (e). Upon the office's receipt of notice of the pregnancy end date, the woman shall be considered conditionally eligible for HIP Plus. The woman shall be eligible to receive coverage in accordance with the process described in 405 IAC 10-3-2; provided, however, that the woman's plan benefits shall not begin earlier than the date of the expiration of the postpartum period described in subsection (e).

  (g) Beginning the first day of the month following the end of the postpartum period described in subsection (c), a woman who remains enrolled in the plan shall:

(1) remain in the same benefit plan but shall no longer be eligible for the enhanced pregnancy benefits described in subsection (c);

(2) be subject to any applicable copayment or POWER account contribution requirements under 405 IAC 10-10-3; and

(3) be subject to the nonpayment penalties described in 405 IAC 10-10-12.

(Office of the Secretary of Family and Social Services; 405 IAC 10-4-6; filed May 18, 2015, 12:34 p.m.: 20150617-IR-405140339FRA)