13.03 Special rule for family policies63

Official source

To the extent that an enrollment in a QHP under a single policy covers two or more individuals who, if they were to enroll in separate policies would be eligible for different cost sharing, AHS will deem the individuals under such policy to be collectively eligible only for the category of eligibility last listed below for which all the individuals covered by the policy would be eligible. Individuals not eligible for changes to cost sharing; § 59.02 (Special cost-sharing rules for Indians, regardless of income); § 13.02(d); § 13.02(c); § 13.02(b); § 13.02(a); § 59.01 (Eligibility for CSR for Indians). Example: Person A is the mother of Person B, her 24-year-old son. Person A and Person B both work and file taxes separately. However, they are covered under the same QHP. Person A’s income is equal to 125 percent of the FPL and Person B’s income is 225 percent of the FPL. Since Person B’s income is at the 225 percent level, the CSR that Person A and Person B will receive will be that available at the 225 percent level, which is in the 200 percent to 250 percent range. Eligibility for enrollment in a catastrophic plan64 (01/01/2018, GCR 17-044) An individual is eligible for enrollment in a catastrophic plan 65 if they have met the requirements for eligibility for enrollment in a QHP, as specified in § 11.00, and they: Have not attained the age of 30 before the beginning of the plan year; or Have a certification in effect for any plan year that they are exempt from the requirement to maintain MEC by reason of hardship, including coverage being unaffordable (see § 23.06(a)). 63 45 CFR § 155.305(g)(3). 64 45 CFR § 155.305(h). 65 45 CFR § 156.155.

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13.03 Special rule for family policies63

Official source

To the extent that an enrollment in a QHP under a single policy covers two or more individuals who, if they were to enroll in separate policies would be eligible for different cost sharing, AHS will deem the individuals under such policy to be collectively eligible only for the category of eligibility last listed below for which all the individuals covered by the policy would be eligible. Individuals not eligible for changes to cost sharing; § 59.02 (Special cost-sharing rules for Indians, regardless of income); § 13.02(d); § 13.02(c); § 13.02(b); § 13.02(a); § 59.01 (Eligibility for CSR for Indians). Example: Person A is the mother of Person B, her 24-year-old son. Person A and Person B both work and file taxes separately. However, they are covered under the same QHP. Person A’s income is equal to 125 percent of the FPL and Person B’s income is 225 percent of the FPL. Since Person B’s income is at the 225 percent level, the CSR that Person A and Person B will receive will be that available at the 225 percent level, which is in the 200 percent to 250 percent range. Eligibility for enrollment in a catastrophic plan64 (01/01/2018, GCR 17-044) An individual is eligible for enrollment in a catastrophic plan 65 if they have met the requirements for eligibility for enrollment in a QHP, as specified in § 11.00, and they: Have not attained the age of 30 before the beginning of the plan year; or Have a certification in effect for any plan year that they are exempt from the requirement to maintain MEC by reason of hardship, including coverage being unaffordable (see § 23.06(a)). 63 45 CFR § 155.305(g)(3). 64 45 CFR § 155.305(h). 65 45 CFR § 156.155.