A General Information About FTW Premiums

Policy

A FTW premium is calculated for all customers who qualify for:

·         AHCCCS Medical Services under an AHCCCS FTW coverage group; or

·         FTW-ALTCS services and do not have a Share of Cost (SOC).

The FTW premium amount is based on the customer’s net countable monthly earned income:

EXCEPTION:

American Indian and Alaska Native customers, as well as the children and grandchildren of tribal members, are not charged a premium when they prove their tribal enrollment (or that of their parent/grandparent).

1)    Proof of Tribal Enrollment

American Indians and Alaska Natives who qualify for FTW must provide proof of tribal enrollment to be exempt from monthly premium charges.  Proof of enrollment or tribal membership includes:

·        Certificate of Degree of Indian Blood;

·        Tribal ID;

·        Tribal Census Record; and

·        Other document provided by the tribe stating that the person is an enrolled member of the tribe.

Children and grandchildren of tribal members must submit documentation that proves they are descendants of a tribal member.  Proof includes:

·        An official letter on tribal letterhead from the tribe stating that the applicant is a child or grandchild of a tribal member; or

·        A document verifying the tribal member’s enrollment in the tribe and a document verifying that the applicant is a child or grandchild of the tribal member.

When a person claiming to be a American Indian, Alaska Native, or the child/grandchild of a tribal member does not provide proof of tribal enrollment, the premium exemption does not apply and a premium may be charged. 

NOTE          Do not deny eligibility because there is no proof of tribal enrollment.

When a person is approved with a premium and later provides proof of tribal enrollment, the person is exempt from paying the premium beginning the month after the proof is provided.

2)    When Do Premiums Begin?

Premiums begin with the month following the month in which the approval is dispositioned.

Premium Examples

3)    Informing Customers of the Premium Amount

An approval notice or change notice is used to:

·         Show the customer how countable earned income was calculated;

·         Inform the customer of the premium amount;

·         Inform the customer of his or her right to appeal the amount of the premium; and

·         Advise the customer to report changes in income or work expenses that could cause a change in the premium amount.

Definitions

Legal Authority