Indiana Code
Chapter 44.5. Healthy Indiana Plan 2.0
12-15-44.5-4.9. Eligibility Period; Renewal; Unused Share of Health Care Account Distribution

Sec. 4.9. (a) An individual who is approved to participate in the plan is eligible for a twelve (12) month plan period if the individual continues to meet the plan requirements specified in this chapter.
(b) If an individual chooses to renew participation in the plan, the individual is subject to an annual renewal process at the end of the benefit period to determine continued eligibility for participating in the plan. If the individual does not complete the renewal process, the individual may not reenroll in the plan for at least six (6) months.
(c) This subsection applies to participants who consistently made the required payments in the individual's health care account. If the individual receives the qualified preventative services recommended to the individual during the year, the individual is eligible to have the individual's unused share of the individual's health care account at the end of the plan period, determined by the office, matched by the state and carried over to the subsequent plan period to reduce the individual's required payments. If the individual did not, during the plan period, receive all qualified preventative services recommended to the individual, only the nonstate contribution to the health care account may be used to reduce the individual's payments for the subsequent plan period.
(d) For individuals participating in the plan who, in the past, did not make consistent payments into the individual's health care account while participating in the plan, but:
(1) had a balance remaining in the individual's health care account; and
(2) received all of the required preventative care services;
the office may elect to offer a discount on the individual's required payments to the individual's health care account for the subsequent benefit year. The amount of the discount under this subsection must be related to the percentage of the health care account balance at the end of the plan year but not to exceed a fifty percent (50%) discount of the required contribution.
(e) If an individual is no longer eligible for the plan, does not renew participation in the plan at the end of the plan period, or is terminated from the plan for nonpayment of a required payment, the office shall, not more than one hundred twenty (120) days after the last date of the plan benefit period, refund to the individual the amount determined under subsection (f) of any funds remaining in the individual's health care account as follows:
(1) An individual who is no longer eligible for the plan or does not renew participation in the plan at the end of the plan period shall receive the amount determined under STEP FOUR of subsection (f).
(2) An individual who is terminated from the plan due to nonpayment of a required payment shall receive the amount determined under STEP SIX of subsection (f).
The office may charge a penalty for any voluntary withdrawals from the health care account by the individual before the end of the plan benefit year. The individual may receive the amount determined under STEP SIX of subsection (f).
(f) The office shall determine the amount payable to an individual described in subsection (e) as follows:
STEP ONE: Determine the total amount paid into the individual's health care account under this chapter.
STEP TWO: Determine the total amount paid into the individual's health care account from all sources.
STEP THREE: Divide STEP ONE by STEP TWO.
STEP FOUR: Multiply the ratio determined in STEP THREE by the total amount remaining in the individual's health care account.
STEP FIVE: Subtract any nonpayments of a required payment.
STEP SIX: Multiply the amount determined under STEP FIVE by at least seventy-five hundredths (0.75).
As added by P.L.30-2016, SEC.32. Amended by P.L.114-2018, SEC.6.

Structure Indiana Code

Indiana Code

Title 12. Human Services

Article 15. Medicaid

Chapter 44.5. Healthy Indiana Plan 2.0

12-15-44.5-1. "Phase Out Period"

12-15-44.5-2. "Plan"

12-15-44.5-2.3. "Preventative Care Services"

12-15-44.5-3. Plan Established; Eligibility; Oversight of Marketing; Promotion of Plan; Ensure Enrollment Distribution; Consumer Protection; Provider Participation; Exemptions

12-15-44.5-3.5. Coverage; Vision and Dental; Preventative Care Services

12-15-44.5-4. Scope of the Plan; Termination of Plan; Obligation of State; Report to Budget Committee

12-15-44.5-4.5. Required Health Care Account; Payments

12-15-44.5-4.7. Application; Pregnant Woman Exemption; Payments; Failure to Make Payments; State Contribution; Change in Health Plan

12-15-44.5-4.9. Eligibility Period; Renewal; Unused Share of Health Care Account Distribution

12-15-44.5-5. Managed Care Organization Responsibilities; Reimbursement; Cultural Competency Standards

12-15-44.5-5.5. Workforce Training and Job Search Program Referral

12-15-44.5-5.7. Nonemergency Services Received in an Emergency Room; Copayment

12-15-44.5-6. Phase Out Funds Deposited From Incremental Hospital Assessment Fees; Notice and Phase Out if Plan Is Terminated

12-15-44.5-7. Phase Out Trust Fund Established; Purpose of the Fund; Uses; Administration; Fund Is Considered a Trust Fund

12-15-44.5-8. Requirements for Use of Money Appropriated to the Fund; Requirements for Use of the Incremental Hospital Assessment Fee; Payment for Health Care Services; Administrative Costs; Profit

12-15-44.5-9. Rules

12-15-44.5-10. Benefits for Adult Group; Negotiation of Plan Limitations