1. Iowa health and wellness plan members shall receive coverage for benefits as specified in section 249A.3, subsection 1, paragraph “v”.

Terms Used In Iowa Code 249N.5

  • Covered benefits: means covered benefits as specified in section 249N. See Iowa Code 249N.2
  • Department: means the department of human services. See Iowa Code 249N.2
  • Federal poverty level: means the most recently revised poverty income guidelines published by the United States department of health and human services. See Iowa Code 249N.2
  • Household income: means household income as determined using the modified adjusted gross income methodology pursuant to section 2002 of the Affordable Care Act. See Iowa Code 249N.2
  • Medicaid: means the program paying all or part of the costs of care and services provided to an individual pursuant to chapter 249A and Tit. See Iowa Code 249N.2
  • Member: means an eligible individual who is enrolled in the Iowa health and wellness plan. See Iowa Code 249N.2
  • plan: means the Iowa health and wellness plan established under this chapter. See Iowa Code 249N.2
 2. a. For members whose household income is at or below one hundred percent of the federal poverty level, the plan shall be administered by the Iowa Medicaid enterprise consistent with program administration applicable to individuals under section 249A.3, subsection 1.

 b. For members whose household income is above one hundred percent but not in excess of one hundred thirty-three percent of the federal poverty level, the plan shall be administered through provision of premium assistance for the purchase of the covered benefits through the American health benefits exchange created pursuant to the Affordable Care Act. The department may pay premiums and supplemental cost-sharing subsidies directly to qualified health plans participating in the American health benefits exchange created pursuant to the Affordable Care Act on behalf of the member.
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