Iowa Code r. 441-86.5 - Effective date of coverage
(1)
Initial application. Coverage for a child who is determined
eligible for the hawki program on the basis of an initial application for
either hawki or Medicaid shall be effective the first day of the month
following the month in which the application is filed, regardless of the day of
the month the application is filed. However, when the child does not meet the
provisions of paragraph 86.2(4)"a," coverage shall be
effective the first day of the month following the month in which health
insurance coverage is lost. Also, a one-month waiting period shall be imposed
for a child who is subject to a monthly premium pursuant to paragraph
86.8(2)"c" when the child's health insurance coverage ended in
the month of application. Exceptions: A waiting period shall not be imposed if
any of the following conditions apply:
a. The
child is moving from Medicaid to hawki.
b. The child has a medical condition that,
without medical care, would cause serious disability, loss of function, or
death.
c. The cost of health
insurance coverage for the child exceeds 5 percent of the family's gross
income. The cost of health insurance for the child shall be the difference
between the premium for coverage with and without the child.
d. The health insurance was provided through
an individual plan.
e. The child's
health insurance coverage was lost due to:
(1)
Domestic violence.
(2) Divorce or
death of a parent.
(3) An
involuntary loss of employment that qualified the parent for dependent
coverage, including but not limited to layoff, business closure, reduction in
hours, or termination.
(4) A job
change to a new employer that does not offer the parent dependent coverage or
that requires a waiting period before children can be enrolled in dependent
coverage.
(5) Utilization of the
maximum lifetime coverage amount.
(6) Expiration of coverage under
COBRA.
(7) Discontinuation of
dependent coverage by the parent's employer.
(8) A reason beyond the control of the
parent, such as a serious illness of the parent, fire, flood, or natural
disaster.
f. The child's
parent is determined eligible for advance payment of the premium tax credit for
enrollment in a qualified health plan through the Health Insurance Marketplace
because the employer-sponsored insurance in which the family was enrolled is
determined unaffordable in accordance with
26 CFR
1.36B-2(c)(3)(v).
g. The cost of family coverage that includes
the child exceeds 9.5 percent of the annual household income.
(2)
Referrals from
Medicaid.
a. Cancellation of
Medicaid. Coverage for children who are determined eligible for the hawki
program due to cancellation of Medicaid benefits shall be effective the first
day of the month after Medicaid eligibility is lost in order to ensure that
there is no break in coverage. However, when such a child does not meet the
provisions of paragraph 86.2(4)"a," coverage shall be
effective the first day of the month following the month in which health
insurance coverage is lost.
b.
Exception: If the child lost Medicaid eligibility solely because of the loss of
income disregards from the implementation of the modified adjusted gross income
methodology, the child may be covered under the hawki program for up to 12
months following the loss of Medicaid eligibility, regardless of the presence
of other health insurance coverage.
(3)
Annual renewals.
Coverage for children who are determined eligible for the hawki program on the
basis of an annual renewal shall be effective the first day of the month
following the month in which the previous enrollment period ended.
(4)
Children added to an existing
hawki enrollment period. Coverage for children who are determined
eligible for the hawki program on the basis of a request from the family to add
the child to an existing enrollment period shall be effective the first day of
the month following the month in which the request was made. However, if the
child does not meet the provisions of paragraph 86.2(4)"a,"
coverage shall be effective the first day of the month following the month in
which health insurance coverage is lost unless the child is subject to a
one-month waiting period in accordance with paragraph
86.2(4)"b."
Notes
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