405 Ind. Admin. Code 10-4-6

Current through October 16, 2024

Section 405 IAC 10-4-6 - HIP Maternity

Authority: IC 12-15-44.5-9

Affected: IC 12-15-44.5

Sec. 6.

(a) A member who becomes pregnant during the member's benefit period shall remain enrolled in the plan.

(b) A pregnant member shall be exempt from cost sharing, including, but not limited to, the following:

(1) HIP Plus monthly contributions set forth in 405 IAC 10-10-3(a).

(2) HIP Basic copayments set forth in 405 IAC 10-10-3(c).

(3) Copayments for nonemergent use of a hospital emergency department set forth in 405 IAC 10-7-9.

(4) Deductible amounts funded through the member's POWER account.

(c) A pregnant member who remains in the plan as described in subsection (a) shall receive enhanced benefits, starting the first day of the month following the pregnancy notification, throughout the member's pregnancy and for a postpartum period equal to twelve (12) months commencing on the date the individual's pregnancy ends.

(d) Beginning the first day of the month following the end of the postpartum period described in subsection (c), a woman who remains enrolled in the plan shall:

(1) be enrolled in HIP Basic with the opportunity to buy-up to HIP Plus;

(2) be subject to applicable copayment or POWER account contribution requirements under 405 IAC 10-10-3; and

(3) be subject to the nonpayment penalties described in 405 IAC 10-10-12.

405 IAC 10-4-6

Filed 5/18/2015, 12:34 p.m.: 20150617-IR-405140339FRA

Filed 1/19/2018, 8:42 a.m.: 20180214-IR-405170484FRA

Errata Filed 2/22/2018, 9:36 a.m: 20180307-IR-405180114ACA

Filed 10/10/2023, 8:03 a.m.: 20231108-IR-405230366FRA