1. (a) To participate in the plan, an individual must:

   1. (1) apply for the plan on a form prescribed by the secretary;
   2. (2) comply with the requirements of section 3(c) of this chapter for the three (3) consecutive months immediately preceding the month the individual applies to the plan; and

   3. (3) provide documentary evidence of compliance with subdivision (2).

      The secretary may not accept self-attestation by the applicant as evidence of compliance. The secretary may develop and allow a joint application for a household.

2. (b) A pregnant woman is not subject to the cost sharing provisions of the plan. Subsections (c) through (g) do not apply to a pregnant woman participating in the plan.

3. (c) An applicant who is approved to participate in the plan does not begin benefits under the plan until a payment of at least:

   1. (1) one-twelfth (1/12) of the annual income contribution amount; or

   2. (2) ten dollars ($10);

      is made to the individual's health care account established under section 4.5 of this chapter for the individual's participation in the plan. To continue to participate in the plan, an individual must contribute to the individual's health care account at least two percent (2%) of the individual's annual household income per year or an amount determined by the secretary that is based on the individual's annual household income per year, but not less than one dollar ($1) per month. The amount determined by the secretary under this subsection must be approved by the United States Department of Health and Human Services and must be budget neutral to the state as determined by the state budget agency.

4. (d) If an applicant who is approved to participate in the plan fails to make the initial payment into the individual's health care account, at least the following must occur:

   1. (1) If the individual has an annual income that is at or below one hundred percent (100%) of the federal poverty income level, the individual's benefits are reduced as specified in subsection (e)(1).
   2. (2) If the individual has an annual income of more than one hundred percent (100%) of the federal poverty income level, the individual is not enrolled in the plan.

5. (e) If an enrolled individual's required monthly payment to the plan is not made within sixty (60) days after the required payment date, the following, at a minimum, occur:

   1. (1) For an individual who has an annual income that is at or below one hundred percent (100%) of the federal income poverty level, the individual is:

      1. (A) transferred to a plan that has a material reduction in benefits, including the elimination of benefits for vision and dental services; and
      2. (B) required to make copayments for the provision of services that may not be paid from the individual's health care account.
   2. (2) For an individual who has an annual income of more than one hundred percent (100%) of the federal poverty income level, the individual shall be terminated from the plan and may not reenroll in the plan for at least six (6) months.
6. (f) The state shall contribute to the individual's health care account the difference between the individual's payment required under this section and the plan deductible set forth in section 4.5(c) of this chapter.

7. (g) A member shall remain enrolled with the same managed care organization during the member's benefit period. A member may change managed care organizations as follows:

   1. (1) Without cause:

      1. (A) before making a contribution or before finalizing enrollment in accordance with subsection (d)(1); or
      2. (B) during the annual plan renewal process.
   2. (2) For cause, as determined by the office under the direction of the secretary.

8. (h) The office may reimburse medical providers at the appropriate Medicaid fee schedule rate for certified medical claims incurred prior to the beginning of benefits under subsection (c) provided that the claims:

   1. (1) were incurred not more than one (1) month prior to the individual's application; and

   2. (2) are on behalf of an individual who:

      1. (A) is approved to participate in the plan;
      2. (B) is enrolled in the plan subject to the provisions in subsection (d); and
      3. (C) was eligible for the plan at the time care and services were furnished.
9. (i) An enrolled individual in the plan must be in compliance with section 3(c) of this chapter in each month in order to remain enrolled in the plan.

As added by P.L.30-2016, SEC.31. Amended by P.L.152-2017, SEC.33; P.L.126-2025, SEC.12; P.L.63-2026, SEC.22.