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Title 5: Centrally Administered Programs Page 2 Iowa Department of Human Services Employees’ Manual Chapter E: Healthy and Well Kids in Iowa (hawk-i) General Administration Revised July 3, 2009 Definitions Definitions “Applicant” means a child for whom a valid application for the hawk-i program has been received. “Capitation rate” means the monthly premium the Department pays to a participating health plan for each enrollee in the hawk-i program for the provision of covered medical services. “Cost sharing” means the monthly premium or copayment paid by the family. “Covered services” means the medical and dental services provided by the participating health plans. “Department” means the Iowa Department of Human Services (DHS). “Director” means the director of the Iowa Department of Human Services. “Eligible child” means an individual who meets the criteria for participation in the hawk-i program. “Enrollee” means a child who has been determined eligible for the hawk-i program and who has been enrolled with a participating health and dental plan. “Federal poverty level” or “FPL” means the poverty income guidelines revised annually and published in the Federal Register by the United States Department of Health and Human Services. “FIP” means the Family Investment Program administered by the Department of Human Services. “Good cause” means the family has demonstrated that one or more of the following conditions exist: ♦ There was a serious illness or death of the enrollee or a member of the enrollee’s family. ♦ There was a family emergency or household disaster, such as a fire, flood, or tornado. ♦ There were other reasons beyond the enrollee’s control. ♦ There was a failure to receive the third-party administrator’s request for a reason not attributable to the enrollee. Lack of a forwarding address is attributable to the enrollee.