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Title 5: Centrally Administered Programs Page 75 Iowa Department of Human Services Employees’ Manual Chapter E: Healthy and Well Kids in Iowa (hawk-i) Premiums and Copayments July 3, 2009 Premiums Premiums and Copayments Legal reference: 441 IAC 86.8(514I) This section contains information on the following: ♦ Premiums ♦ Due date for initial premiums ♦ Due date for ongoing premiums ♦ Failure to pay ♦ Reinstatement ♦ Copayment Premiums Legal reference: 441 IAC 86.8(514I) Participation in the program is contingent upon payment of a monthly premium when the countable income is equal to or greater than 150 percent of the federal poverty level for a family of the same size. The monthly premium is determined by applying the following formula:

Gross earned income - 20% earned income deduction + Unearned income_______________________ = Countable income used to determine premium If the countable income is equal to or less than 200% of the federal poverty level, the premium will be $10 per month per child with a $20 monthly family cap. If the countable income is equal to or greater than 201% of the federal poverty level, the premium will be $20 per month per child with a $40 monthly family cap. No premium is assessed: ♦ When countable income is less than 150% of the federal poverty level for a family of the same size. ♦ For eligible Native American or Alaskan Native children regardless of family income.