70.02 Premium obligation; initial billing and payment

Initial billing. An individual who is approved for Medicaid with a premium obligation will be notified of the premium obligation and premium amount in a bill that will be sent at the time of approval. The individual will not be enrolled in Medicaid until AHS receives payment of the initial premium. The bill will include payment instructions. If the premium payment is made by mail, the payment will be considered received as of the date it is postmarked. (b) Initial premium bill amount The initial bill will include premium charges for the month in which the individual’s application was received (the application month) and the month following the application month if eligibility is approved in the same month as the application month. The premium due date is the last day of the month following the application month. If the month eligibility is approved is different than the application month, the initial bill will include the application month, the approval month, any month (or months) between the application month and the approval month, and the month following the approval month. The premium due date is the last day of the month following the approval month. If the individual is eligible for, and requests, retroactive coverage at the time of their initial application, the initial bill will include premium charges for each month of retroactive coverage. See § 70.01(b) for details on the requirements that must be met for retroactive eligibility. (c) Payment allocation. When a premium payment is made for the initial months of coverage, and the payment covers the premiums due for at least one, but fewer than all, of the months included in the bill, the payment will be allocated in reverse chronological order, beginning with the latest month included in the bill and extending back as follows: (1) each month between the latest month and the application month, (2) the application month, and (3) any retroactive coverage months included in the bill. Coverage will begin on the first day of the earliest month for which a full premium has been paid in accordance with the allocation method described above. Once an individual is in an ongoing billing cycle due to the issuance of a bill for a subsequent month not included in the bill for the initial months, payments will be applied to the coverage month for which the latest bill was issued and to future coverage months. See § 64.04 for a description of the ongoing billing and payment process. (d) Coverage islands; premiums paid after enrollment Individuals who initially pay the premiums due for fewer than all of the months included in the initial bill may subsequently obtain coverage islands for any or all of the remaining months (a “coverage island” is a period of eligibility with specific beginning and end dates). To obtain one or more coverage islands, the individual must pay the full premium amount that was initially billed for each of the desired months of coverage. Eligibility-and-Enrollment Procedures Part 7 – Page 57 (Sec.71.00, Sub.71.01) Payments of coverage islands will be allocated in the order specified in paragraph (c) of this § 70.02. Enrollment of qualified individuals in QHPs123 (01/01/2026, GCR 25-055)