Authority: IC 12-15-44.5-9

Affected: IC 12-15-2-20; IC 12-15-2.5-2; IC 12-15-44.5

Sec. 5. (a) To receive reimbursement for a private or employer-based health insurance plan premium, the participant shall, within ninety (90) days of the date the premium was incurred by the participant:

1. (1) complete the applicable form prescribed by the office providing the name of the participant, the amount of the premium, the date the premium was incurred, and the amount claimed;
2. (2) include with the form documentation to support the cost of the premium incurred by the participant; and
3. (3) submit the form and supporting documentation to the office via email or U.S. mail.

(b) In order to generate direct payment for a premium for a health insurance plan on the federally-facilitated Exchange (FFE), as defined in 45 CFR 155.20, a participant in the program must perform the following actions within ninety (90) days of the date on which the cost of the premium was incurred by the participant:

1. (1) Complete the applicable form prescribed by the office and submit via email or U.S. mail.
2. (2) Include with the form the documentation to support the cost of the premium owed by the participant to the plan on the FFE.
3. (3) Submit the form and supporting documentation to the office via email or U.S. mail.

(c) Documentation supporting the cost of the premium must indicate the provider of the insurance, group number, policy number, and the cost of the premium. Supporting documentation may include:

1. (1) for a private health insurance plan:

   1. (A) an invoice;
   2. (B) plan documentation establishing premium payments;
   3. (C) an electronic payment agreement; or
   4. (D) other documentation from the health insurance plan documenting the amount of the premium and frequency of payment.

2. (2) for an employer-provided insurance plan:

   1. (A) a letter signed by the employer stating the cost of the premium and frequency of deduction from the participant's pay;
   2. (B) a pay stub documenting the amount and frequency of the premium payment; or
   3. (C) other documentation from the employer documenting the amount of the premium and frequency of payment.

3. (3) for an FFE plan:

   1. (A) an invoice;
   2. (B) plan documentation establishing premium payments;
   3. (C) an electronic payment agreement; or
   4. (D) other documentation from the health insurance plan documenting the amount of the premium and frequency of payment.

A participant who submits documentation in support of the premium other than the examples listed above must demonstrate the reliability and appropriateness of the documentation.

(d) Direct payment may be generated only for the payment of a premium for a plan on the FFE.

(e) Direct payment to a provider as specified in section 4(c)(3) of this rule shall follow the claims procedure described in 405 IAC 1-1-3 and does not require any action by the participant.

(f) No payment of program funds shall be provided in excess of the limits specified in section 7 of this rule.

(Office of the Secretary of Family and Social Services; 405 IAC 10-13-5; filed Jul 9, 2021, 2:05 p.m.: 20210804-IR-405210032FRA; readopted filed Oct 16, 2024, 11:20 a.m.: 20241113-IR-405230817RFA)