D Premium Hardship Waiver for KidsCare

Policy

A person may request to waive a child's premium for the prior or current month due to a hardship in the month.  When the premium is waived for the current month, the premium for the prior month is also waived even when there are no expenses in that month.

The main contact must have paid or be required to pay the expense during the month the premium is waived.  When the premium is waived and the customer does not pay the expense, the premium cannot be waived again using the same expense.  When a person has ongoing expenses, the premium may be waived for future months as well.  When the premium is waived for future months, it must be reevaluated at renewal.

A hardship exists when a member of the budget group died or the budget group has one or more of the following expenses which exceed 10% of the countable gross income of the budget group:

·        Medically necessary expenses for any member of the budget group that insurance did not pay for.  Medically necessary means a covered service provided by a physician or other licensed practitioner to prevent disease, disability, or other adverse health conditions or their progression or prolong life;

·        Health insurance premiums for any member of the budget group;

·        Unexpected expenses for repairs to the home.  Repairs include items such as fixing a leaky roof, replacing a non-working air conditioner, repairing plumbing, etc.  Repairs do not include remodeling or redecorating; or

·        Expenses for repairs to a budget group member’s transportation so the individual can get to work.  This does not include routine maintenance such as tune-ups, oil changes, etc.

1)    Proof

The Main Contact’s statement on the written request as proof of income and death of a budget group member is accepted.

The Main Contact must provide proof of the expense(s).  Proof of the expense(s) includes a copy of the bill or receipt that shows the type, date, and amount of the expense.  An estimate is not considered proof.

2)    Re-Evaluate Waiver at Renewal

When the premium is currently waived on an ongoing basis, the hardship waiver will be reviewed again at time of renewal even when benefits are being discontinued.  When the children remain eligible for the hardship waiver and appeal the discontinuance, the premium is waived during the appeal process.

Definitions

Legal Authority