PURPOSE: This rule establishes the general payment provisions for eligible seniors for the Missouri Senior Rx Program.

1. (1) An applicant becomes eligible for the program when the application is received and approved by the third-party administrator, the applicant has paid the enrollment fee, the applicant receives a program identification card, and the program identification card is activated.
2. (2) An applicant for the program shall pay, in the initial year, an enrollment fee of twentyfive dollars ($25) if the applicant has an annual household income at or below twelve thousand dollars ($12,000) for an individual or at or below seventeen thousand dollars ($17,000) for a married couple or an enrollment fee of thirty-five dollars ($35) if the applicant has an annual household income between twelve thousand one dollars and seventeen thousand dollars ($12,001–$17,000) for an individual or between seventeen thousand one dollars and twenty-three thousand dollars ($17,001–$23,000) for a married couple. The enrollment fee may be adjusted by the commission to obtain program cost control under sections 208.550 to 208.571, RSMo.
3. (3) A claimant for the program shall pay, in the initial year, a deductible of two hundred fifty dollars ($250) if the claimant has an annual household income at or below twelve thousand dollars ($12,000) for an individual or at or below seventeen thousand dollars ($17,000) for a married couple or a deductible of five hundred dollars ($500) if the claimant has an annual household income between twelve thousand one dollars and seventeen thousand dollars ($12,001–$17,000) for an individual or between seventeen thousand one dollars and twenty-three thousand dollars ($17,001–$23,000) for a married couple. The deductible may be adjusted by the commission to obtain program cost control under sections 208.550 to 208.571, RSMo.
4. (4) A claimant for the program shall pay a forty percent (40%) coinsurance. The coinsurance may be adjusted by the commission on an annual basis or through the third-party administrator during the plan (or fiscal) year to obtain program cost control under sections 208.550 to 208.571, RSMo.

AUTHORITY: section 208.553.3(5), RSMo Supp. 2001.* Emergency rule filed Jan. 16, 2002, effective March 1, 2002, expired Aug. 27, 2002. Original rule filed Jan. 16, 2002, effective Aug. 30, 2002. *Original authority: 208.553, RSMo 2001.