Authority: IC 12-17.6-2-11

Affected: IC 12-17.6-4-3

Sec. 3. (a) The total annual aggregate cost-sharing for a family may not exceed five percent (5%) of the family's income for the twelve (12) month period beginning on the date that the child's eligibility is determined. As used in this section, "total aggregate cost-sharing" means premiums and copayments paid by the member or the member's parent or guardian. For purposes of this section, the family's income includes the income considered in 407 IAC 2-2-2 [ 405 IAC 12-2-2].

(b) The member's family is responsible for informing the local office when the total aggregate cost-sharing for the family has reached five percent (5%) of the family's income and for maintaining documentation to substantiate the amount of cost-sharing paid by the family. When the member provides the local office with documentary verification that the total aggregate cost-sharing for a family has reached five percent (5%) of the family's income for the twelve (12) month period:

1. (1) the member's parent or guardian will not be required to pay any premiums for the remainder of the twelve (12) month period; and
2. (2) the office will refund any copayments paid during the remainder of the twelve (12) month period.

(Office of the Secretary of Family and Social Services; 405 IAC 12-3-3; filed May 3, 2000, 2:02 p.m.: 23 IR 2234; readopted filed May 22, 2006, 3:22 p.m.: 29 IR 3424; readopted filed Jun 18, 2012, 11:23 a.m.: 20120718-IR-407120202RFA; readopted filed Apr 9, 2018, 9:12 a.m.: 20180509-IR-405180110RFA; readopted filed Oct 16, 2024, 11:20 a.m.: 20241113-IR- 405230817RFA) NOTE: Transferred from the Office of the Children's Health Insurance Program ( 407 IAC 2-3-3) to the Office of the Secretary of Family and Social Services ( 405 IAC 12-3-3) by P.L.35-2016, SECTION 53, effective March 21, 2016.