Sec. 10.09.43.13. Program Participation Requirements — Family Contribution

A. Family Contribution Required. As a requirement of enrollment and participation in MCHP Premium, the representative of an eligible individual shall agree to pay the following annual family contribution:

(1) For an eligible individual whose family income is above 200 percent but at or below 250 percent of the FPL, an amount equal to 2 percent of the annual income of a family of two at 200 percent of the FPL; and

(2) For an eligible individual whose family income is above 250 percent, but at or below 300 percent of the FPL, an amount equal to 2 percent of the annual income of a family of two at 250 percent of the FPL.

B. The family contribution amounts required under §A of this regulation apply on a per family basis regardless of the number of eligible individuals each family has enrolled in MCHP Premium.

C. American Indians and Alaskan Natives are exempt from a family contribution requirement.

D. Payment Procedures.

(1) The representative shall send the initial month's payment to the Department or its designee by electronic transfer, money order, or check.

(2) For months following the initial month of coverage:

(a) The Department or its designee shall bill at the start of each month for the next month's family contribution and shall provide a self-addressed stamped envelope for return of the family contribution;

(b) The representative shall make the family contribution payment in full to continue coverage, unless the representative claims that payment will cause hardship as defined in Regulation .02B of this chapter;

(c) The Department or its designee shall notify the applicant of the amount due and instruct on the manner of payment and date due, if timely payment has not been made; and

(d) The applicant shall make payment in full of amounts due to the Department or its designee no later than 30 days after the date of issuance of a request for payment, to ensure continuing eligibility unless the representative claims that payment will cause hardship as defined in Regulation .02B of this chapter.

E. Hardship.

(1) The applicant shall submit the claim of hardship in writing within 10 days of receipt of the Department's request for payment.

(2) The Department shall evaluate claims of hardship and notify the applicant of the decision within 30 days of receipt of the written claim of hardship.

F. Consequences of Nonpayment.

(1) If payment is not waived or due date adjusted due to hardship, the applicant shall make payment in full not later than 30 days after the date of issuance of a request for payment.

(2) If the applicant fails to comply with §F(1) of this regulation:

(a) The individual shall have eligibility terminated, effective the first day of the month following the month for which payment was due; and

(b) The case shall be referred to the Central Collections Unit of the Department of Budget and Management for collection.

(3) An individual whose eligibility was terminated due to failure to pay the Department as specified in §D(2)(d) of this regulation is ineligible for participation in MCHP Premium until 90 days from the notice date of termination or the date payment has been made in full, whichever is sooner.