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2. Determine if a Premium is due.

a. Calculate the amount of total countable net earned and unearned income for the individual.

b. Those with unearned income above 150% FPL are not eligible for HCWD. c. If total countable monthly income exceeds 200% of FPL, a premium is due. Use chart above to determine premium amount.

Note: Members of federally recognized Native American tribes and Alaska natives are exempt from cost sharing, including premiums and enrollment fees.

3. Notification of Premium due:

Notify the a/b in writing that a premium is due by mailing DHB-5146, Health Coverage for Workers with Disability Premium Notice.

a. Date the premium invoice the date it will be mailed.

b. The invoice must identify the premium amount due for each month separately.

c. The caseworker must provide their name, direct phone number and email address on the invoice.

d. If an enrollment fee is due, mail the premium invoice with the enrollment fee notice.

e. Allow the a/b 12 calendar days to pay the premium. Day one is the day after the invoice is mailed.

f. Payment must be by certified check or money order payable to: “NC DHHS” and “HCWD Premium” must be written on the memo line of the check.

g. The payment must be mailed to:

DHHS Controller Office 2019 Mail Service Center Raleigh, NC 27699-2019

h. When the premium payment is made, North Carolina (NC) Medicaid will notify the county worker designated on the invoice by telephone and email a copy of the invoice and check to the Docusign Envelope ID: B8C63DC7-7367-4210-853E-B7B004802EE4