Member Financial Liability. The Contractor shall educate network Providers to collect Co-Payments from Members in accordance with Table 2. Table 2. Allowable Cost Sharing by FPL Requirement ≤150% FPL 151% to 175% FPL 176% to 209% FPL Per Physician Visit None $5.00 $5.00 Per Emergency Room Visit None $15.00 $15.00 Out-of-Pocket Maximum N/A $800.00 $950.00 The Contractor shall track the amount of Co-Payments collected in a given calendar year. When a Member meets his or her Out-of-Pocket Maximum, the Contractor shall send a letter to the Member indicating that no further Co-Payments should be paid for the remainder of the State Fiscal Year. The Contractor shall include instructions in the letter to present the letter when future health services are sought, or request the Provider to contact the Contractor regarding this issue. The Contractor must submit the template letter to the Division thirty (30) calendar days prior to use for the Division review. No Cost Sharing may be collected from these CHIP Members for the balance of the State Fiscal Year. The Contractor shall comply with all Cost Sharing restrictions imposed on Members by Federal or State laws and regulations, including the following specific provisions:
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Member Financial Liability. The Contractor shall educate network Providers to collect Co-Payments from Members in accordance with Table 2. Table 2. Allowable Cost Sharing by FPL Requirement ≤150% FPL 151% to 175% FPL 176% to 209% FPL Per Physician Visit None $5.00 $5.00 Per Emergency Room Visit None $15.00 $15.00 Out-of-Pocket Maximum N/A $800.00 $950.00 The Contractor shall track the amount of Co-Payments collected in a given calendar year. When a Member meets his or her Out-of-Pocket Maximum, the Contractor shall send a letter to the Member indicating that no further Co-Payments should be paid for the remainder of the State Fiscal Year. The Contractor shall include instructions in the letter to present the letter when future health services are sought, or request the Provider to contact the Contractor regarding this issue. The Contractor must submit the template letter to the Division thirty (30) calendar days prior to use for the Division review. No Cost Sharing may be collected from these CHIP Members for the balance of the State Fiscal Year. The Contractor shall comply with all Cost Sharing restrictions imposed on Members by Federal or State laws and regulations, including the following specific provisions:
Appears in 2 contracts
