WAC 182-505-0225

Effective July 1, 2012

WAC 182-505-0225 Premium-based Washington apple health for kids -- Premium requirements.



(1) For the purposes of this chapter, "premium" means an amount paid for Washington apple health (WAH) coverage for kids as described in WAC 182-505-0210(4).

(2) Payment of a premium is required as a condition of eligibility for premium-based WAH coverage for kids, as described in WAC 182-505-0210(4), unless the child is:

(a) Pregnant; or

(b) An American Indian or Alaska native.

(3) The premium requirement begins the first of the month following the determination of eligibility. There is no premium requirement for WAH coverage received in a month or months before the determination of eligibility.

(4) The premium amount is limited to a monthly maximum of two premiums for families with two or more children.

(5) The premium amount is:

(a) Twenty dollars per month per child for families with countable income above two hundred ten percent FPL, but not above two hundred sixty percent FPL; or

(b) Thirty dollars per month per child for families with countable income above two hundred sixty percent FPL, but not above three hundred twelve percent FPL.

(6) All children in an assistance unit (AU) are ineligible for WAH coverage when the family fails to pay required premium payments for three consecutive months.

(7) When the agency or its designee terminates the WAH coverage due to nonpayment of premiums, the child's eligibility is restored when the:

(a) Past due premiums are paid in full prior to the end of the certification period; or

(b) The child becomes eligible for coverage under WAH without a premium.

(8) The agency or its designee writes off past-due premiums after twelve months.

(9) If all past due premiums are paid after the certification period is over:

(a) Eligibility for prior months is not restored; and

(b) Children are not eligible for premium-based WAH for kids until:

(i) The month the premiums are paid or the agency writes off the debt; and

(ii) The family reapplies and is found eligible.

(10) A family cannot designate partial payment of the billed premium amount as payment for a specific child in the AU. The full premium amount is the obligation of the head of household of the AU. A family can decide to request health care coverage only for certain children in the AU, if they want to reduce premium obligation.

(11) A change that affects the premium amount is effective the month after the change is reported and processed.

(12) A sponsor or other third party may pay the premium on behalf of the child or children in the AU. The premium payment requirement remains the obligation of head of household of the AU. The failure of a sponsor or other third party to pay the premium does not eliminate the obligation of the head of household to pay past due premiums.

This is a reprint of the official rule as published by the Office of the Code Reviser. If there are previous versions of this rule, they can be found using the Legislative Search page.