Iowa Code 249N.7 – Member financial participation
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1. Membership in the Iowa health and wellness plan shall require payment of monthly contributions for members whose household income is at or above fifty percent of the federal poverty level. Members shall be subject to copayment amounts applicable only to nonemergency use of a hospital emergency department. Total member cost-sharing, annually, shall align with the cost-sharing limitations requirements for the American health benefits exchanges under the Affordable Care Act. Contributions and copayment amounts shall be established by rule of the department.
Terms Used In Iowa Code 249N.7
- 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
- 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
- Preventive care services: means care that is provided to an individual to promote health, prevent disease, or diagnose disease. See Iowa Code 249N.2
- Rule: includes "regulation". See Iowa Code 4.1
- year: means twelve consecutive months. See Iowa Code 4.1
2. Contributions shall be waived for a member during the initial year of membership. If a member completes all required preventive care services and wellness activities as specified by rule of the department during the initial year of membership, contributions shall be waived during the subsequent year of membership and each year thereafter until such time as the member fails to complete required preventive care services and wellness activities specified during the prior annual membership period.