Conditionally Eligible Enrollee definition
Conditionally Eligible Enrollee means an applicant who has been determined to meet all Kentucky HEALTH eligibility criteria, but who has not made an initial premium payment or otherwise cleared a penalty in order to start coverage. Conditionally Eligible Enrollees are not eligible to receive Kentucky HEALTH benefits. Copayment Plan is the cost sharing plan for ACA Expansion Enrollees, Parent and Caretaker Relatives, and TMA Enrollees at or below one hundred percent (100%) FPL who fail to make required Kentucky HEALTH premium payments. Enrollees in the Copayment Plan do not have access to a My Rewards Account, and are charged copayments for Covered Services in accordance with the Kentucky Medicaid State Plan. Cost Sharing Exempt refers to Kentucky HEALTH Enrollees who are excluded from the requirement or option to contribute toward the cost of their health coverage. It includes Pregnant Women and Kentucky HEALTH Children. Cost Sharing Optional refers to Kentucky HEALTH Enrollees who are not required to contribute toward the cost of their health coverage as a condition of eligibility. It includes Former ▇▇▇▇▇▇ Youth to age 26 and Medically Frail Individuals. These Enrollees can choose to make monthly Kentucky HEALTH premium payments in order to gain access to a My Rewards Account. Cost Sharing Required includes ACA Expansion Enrollees, Parent and Caretaker Relatives, and TMA Enrollees who are required to contribute to the cost of their coverage via monthly premium payments or copayments for every Kentucky HEALTH covered benefit received. Debt means any unpaid premium amounts the Contractor may collect from an Enrollee. Payment of Debt is neither a condition of eligibility nor required to cure a Non-Payment Penalty. Deductible Account is state-funded administrative tracking account in the amount of one thousand dollars ($1,000.00) designed to expose Kentucky HEALTH Enrollees to the cost of healthcare, designed to encourage them to be active consumers by evaluating cost and quality of care. It is funded with State dollars, not with Contractor or Enrollee dollars. The first one thousand dollars ($1,000.00) of non-preventive services received by Enrollees within a benefit year are tracked against the Deductible Account and documented on a monthly statement sent to Enrollees. Half of the remaining Deductible Account balance at the end of the benefit year (up to five hundred dollars [$500.00]) is eligible to be rolled over into the My Rewards Account. Deemed Newborns are children enrolled in Ken...