Common use of Member Cost Clause in Contracts

Member Cost. Sharing Effective July 1, 2010, federal regulations at 42 CFR 447.78 place aggregate limits on cost-sharing and prohibit total member cost-sharing per family—including POWER Account contributions, premiums, co-payments and co-insurance—from exceeding five percent (5%) of the family’s income, as determined by the State, in a monthly or quarterly period. To ensure a family’s total cost-sharing does not exceed five percent (5%) of the family’s income on a quarterly basis, the Contractor shall accept family income data from the State’s fiscal agent and track the POWER Account contributions, premiums, tobacco surcharge, co-payments, member debt collected and/or other cost-sharing information available to the Contractor against the total family income data provided by the State. Any service not specifically listed as a covered benefit in the applicable HIP alternative benefit plan may not be applied against the member’s five percent (5%) contribution calculation. The time period for tracking data shall be defined by the State. When a family’s total cost-sharing expenditures come close to exceeding five percent (5%) of the family’s income in the quarterly period, the Contractor shall be required to notify the State. The Contractor shall also coordinate with the State to notify providers and the family that additional cost-sharing during the period is reduced or waived. Members with tobacco surcharge will still be responsible for the $1.50 POWER Account contribution once they meet the five percent (5%) limit. In monitoring the quarterly five percent (5%) member cost-sharing limit, the Contractor EXHIBIT 2.H HEALTHY INDIANA PLAN SCOPE OF WORK shall comply with all policies and procedures set forth in this section and the HIP MCE Policies and Procedures Manual.

Member Cost. Sharing Effective July 1, 2010, federal regulations at 42 CFR 447.78 place aggregate limits on cost-sharing and prohibit total member cost-sharing per family—including POWER Account contributions, premiums, co-payments and co-insurance—from exceeding five percent (5%) of the family’s income, as determined by the State, in a monthly or quarterly period. To ensure a family’s total cost-sharing does not exceed five percent (5%) of the family’s income on a quarterly basis, the Contractor shall accept family income data from the State’s fiscal agent and track the POWER Account contributions, premiums, tobacco surcharge, co-payments, member debt collected and/or other cost-sharing information available to the Contractor against the total family income data provided by the State. Any service not specifically listed as a covered benefit in the applicable HIP alternative benefit plan may not be applied against the member’s five percent (5%) contribution calculation. The time period for tracking data shall be defined by the State. When a family’s total cost-sharing expenditures come close to exceeding five percent (5%) of the family’s income in the quarterly period, the Contractor shall be required to notify the State. The Contractor shall also coordinate with the State to notify providers and the family that additional cost-sharing during the period is reduced or waived. Members with tobacco surcharge will still be responsible for the $1.50 POWER Account contribution once they meet the five percent (5%) limit. In monitoring the quarterly five percent (5%) member cost-sharing limit, the Contractor EXHIBIT 2.H HEALTHY INDIANA PLAN SCOPE OF WORK shall comply with all policies and procedures set forth in this section and the HIP MCE Policies and Procedures Manual.

Member Cost. Sharing Effective July 1, 2010, federal regulations at 42 CFR 447.78 place aggregate limits on cost-sharing and prohibit total member cost-sharing per family—including POWER Account contributions, premiums, co-payments and co-insurance—from exceeding five percent (5%) of the family’s income, as determined by the State, in a monthly or quarterly period. To ensure a family’s total cost-sharing does not exceed five percent (5%) of the family’s income on a quarterly basis, the Contractor shall accept family income data from the State’s fiscal agent and track the POWER Account contributions, premiums, tobacco surcharge, co-payments, member debt collected and/or other cost-sharing information available to the Contractor against the total family income data provided by the State. Any service not specifically listed as a covered benefit in the applicable HIP alternative benefit plan may not be applied against the member’s five percent (5%) contribution calculation. The time period for tracking data shall be defined by the State. When a family’s total cost-sharing expenditures come close to exceeding five percent (5%) of the family’s income in the quarterly period, the Contractor shall be required to notify the State. The Contractor shall also coordinate with the State to notify providers and the family that additional cost-cost- sharing during the period is reduced or waived. Members with tobacco surcharge will still be responsible for the $1.50 POWER Account contribution once they meet the five percent (5%) limit. In monitoring the quarterly five percent (5%) member cost-sharing limit, the Contractor EXHIBIT 2.H HEALTHY INDIANA PLAN SCOPE OF WORK shall comply with all policies and procedures set forth in this section and the HIP MCE Policies and Procedures Manual.

Member Cost. Sharing Effective July 1, 2010, federal regulations at 42 CFR 447.78 place aggregate limits on cost-cost- sharing and prohibit total member cost-sharing per family—including POWER Account contributions, premiums, co-payments and co-insurance—from exceeding five percent (5%) of the family’s income, as determined by the State, in a monthly or quarterly period. To ensure a family’s total cost-sharing does not exceed five percent (5%) of the family’s income on a quarterly basis, the Contractor shall accept family income data from the State’s fiscal agent and track the POWER Account contributions, premiums, tobacco surcharge, co-payments, member debt collected and/or other cost-sharing information available to the Contractor against the total family income data provided by the State. Any service servic e not specifically listed as a covered benefit in the applicable HIP alternative benefit plan may not be applied against the member’s five EXHIBIT 2.I SCOPE OF WORK – HEALTHY INDIANA PLAN percent (5%) contribution calculation. The time period for tracking data shall be defined by the State. When a family’s total cost-sharing expenditures come close to exceeding five percent (5%) of the family’s income in the quarterly period, the Contractor shall be required to notify the State. The Contractor shall also coordinate with the State to notify providers and the family that additional cost-sharing during the period is reduced or waived. Members with tobacco surcharge will still be responsible for the $1.50 POWER Account contribution once they meet the five percent (5%) limit. In monitoring the quarterly five percent (5%) member cost-sharing limit, the Contractor EXHIBIT 2.H HEALTHY INDIANA PLAN SCOPE OF WORK shall comply with all policies and procedures set forth in this section and the HIP MCE Policies and Procedures Manual.