Sec. 10.09.41.07. Premium

A. Submission of Premium.

(1) Unless an exception under §A(2) of this regulation applies or a timely claim of hardship is raised pursuant to §C of this regulation, an applicant or recipient shall, as a condition of eligibility for the EID coverage group, pay the premium specified in §A(3) of this regulation.

(2) Limitation of Premium Requirement.

(a) An applicant or recipient with income at or below the federal poverty level is not required to pay a premium as a condition of eligibility in the EID coverage group.

(b) With respect to an applicant determined eligible subject to the requirements of §A(3) of this regulation, the Department shall waive the premium payment before the notice of eligibility for a period not to exceed 6 months if such notice of eligibility is delayed by factors beyond the applicant’s control.

(3) An applicant or recipient whose assistance unit has income:

(a) Above the federal poverty level, but at or below 200 percent of the federal poverty level, shall pay a monthly premium of $25;

(b) Above 200 percent, but at or below 250 percent of the federal poverty level, shall pay a monthly premium of $40; or

(c) Above 250 percent, but at or below 300 percent of the federal poverty level, shall pay a monthly premium of $55.

(4) Request for Payment. With respect to an applicant or recipient determined eligible subject to the requirements of §A(3) of this regulation, the Department shall issue a request for payment of the applicable premium, indicating that the applicant or recipient shall pay the amount specified within 30 days of the date the Department mailed the request for payment.

(5) An applicant or recipient to whom §A(3) of this regulation applies shall, within 30 days of the Department’s request for payment pursuant to Regulation §A(4) of this regulation:

(a) Pay the full premium due as specified in the request for payment issued pursuant to §A(4) of this regulation; or

(b) Submit a claim of hardship as authorized by §C of this regulation.

(6) Upon request by the recipient, the Department shall approve an unemployment grace period, not to exceed 6 months within a 12-month period, provided the recipient:

(a) Has unemployment due to medical reasons or involuntary job loss;

(b) Is otherwise eligible for EID; and

(c) Continues to pay the premium during the unemployment grace period.

B. Nonpayment of Premium.

(1) If an applicant who is required to pay a premium under §A(3) of this regulation, and is the subject of a request for payment issued by the Department pursuant to §A(4) of this regulation, does not pay the premium or submit a hardship claim within 30 days of the Department’s notice, the Department shall:

(a) Determine the applicant is not eligible for the EID coverage group; and

(b) Issue a denial notice as required by Regulation .08C(1) of this chapter.

(2) If recipient who is required to pay a premium under §A(3) of this regulation, and is the subject of a request for payment issued by the Department pursuant to §A(4) of this regulation, does not pay the premium or submit a hardship claim within 30 days of the Department’s notice, the Department shall:

(a) Determine the recipient is not eligible for the EID coverage group;

(b) Issue a termination notice as required by Regulation .08C(2) of this chapter; and

(c) Refer the recipient to the Central Collection Unit.

(3) An applicant or recipient whose eligibility is denied or terminated due to failure to pay the premium as specified in §A(4) of this regulation may not be reenrolled in the EID coverage group until the applicant or recipient pays all monies due to the Department in full.

C. Hardship.

(1) If the applicant or recipient suffers financial adversity or misfortune so severe that payment of the premium would compromise the applicant’s or recipient’s ability to obtain and provide basic food, shelter, and clothing for members of the assistance unit or other legal dependents of the applicant or recipient, the applicant or recipient may submit a claim of hardship, specifying the underlying circumstances, to the Department.

(2) The Department shall evaluate the claim of hardship and notify the applicant or recipient of its decision within 30 days of the Department's receipt of the written claim of hardship.

(3) If the Department determines that the applicant or recipient's claim of hardship is without merit, the applicant or recipient shall pay the applicable premium within 10 days after the date the Department's notice is issued pursuant to §C(2) of this regulation.