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MEDICAL SERVICES POLICY MANUAL,SECTION F
F 100 Non Financial Eligibility Requirements
EXAMPLE 2: Same family with less income reported. • $46,500.00 - $1,800.00 ($600 x 3) - $9,463.25 = $38,336.75 Comparing income in Chart 1 in Appendix P, the annual income is below the limit for a family size of five (5). Therefore, no premium is required. If the custodial parent alleges that household income has decreased significantly since filing the Federal Income Tax Return, additional verification can be submitted to determine current income. NOTE: A stepparent living in the home will be considered a custodial parent and their income will be included when determining the premium amount.
See Appendix P for the amount of premiums to be paid. Themaximum annual premium amount to be paid by any family is five thousand five hundred dollars ($5,500). Families having more than one (1) child receiving TEFRAWaiver benefits will pay only one premium for all covered children. There will be no increase in premium amount for additional Waiver children.
F-172 Adjustment of Premiums MS Manual 07/01/20 Premiums will begin in the month after eligibility is approved. The premium will be charged on a monthly basis and will not be pro-rated. Income will be reviewed annually for calculation of the premium, when there is a change that will make a difference of more than 10% in annual household income or a change in the number of family members. An adjustment can be made to the premium during the year if a significant change is reported in excess of 10% of the expected annual income or if there is a change in the household size. Verification of the income change must be provided. Income that fluctuates due to seasonal employment will not affect the monthly premium. The premium can only be adjusted a maximum ofonce every six months.
F-180 Other Health Insurance Coverage MS Manual 04/01/26 For most eligibility groups, an individual may be covered by other health insurance without affecting their eligibility for Health Care. There are two (2) exceptions to this which are described below.