WAC 388-505-0211 Premium requirements for premium-based healthcare coverage under programs included in apple health for kids.

1. For the purposes of this chapter, "premium" means an amount paid for coverage under programs included in apple health for kids.
2. Payment of a premium is required as a condition of eligibility for premium-based coverage under programs included in apple health for kids, as described in WAC 388-505-0210 (4),  unless the child is:
   1. Pregnant; or
   2. 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 medical coverage received in a month or months before the determination of eligibility.
4. The premium amount for the assistance unit is based on the net countable income as described in WAC 388-450-0210 and the number of children in the assistance unit.  If the household includes more than one assistance unit, the premium amount billed for the assistance units may be different amounts.
5. The premium amount for each eligible child shall be:
   1. Twenty dollars per month per child for households with income above two hundred percent FPL, but not above two hundred and fifty percent FPL;
   2. Thirty dollars per month per child for households with income above two hundred and fifty percent FPL, but not above three hundred percent FPL; and
   3. Limited to a monthly maximum of two premiums for households with two or more children.
6. All children in an assistance unit are ineligible for healthcare coverage when the head of household fails to pay required premium payments for three consecutive months.
7. When the department terminates the medical coverage of a child due to nonpayment of premiums, the child has a three-month period of  ineligibility beginning the first of the following month. The three-month period of ineligibility is rescinded only when the:
   1. Past due premiums are paid in full prior to the begin date of the period of ineligibility; or
   2. The child becomes eligible for coverage under a nonpremium-based healthcare program. The department will not rescind the three-month period of ineligibility for reasons other than the criteria described in this subsection.
8. The department writes off past-due premiums after twelve months.
9. When the designated three-month period of ineligibility is over, all past due premiums that are an obligation of the head of household must be paid or written off before a child can become eligible for premium-based coverage under a program included in apple health for kids.
10. A family cannot designate partial payment of the billed premium amount as payment for a specific child in the assistance unit. The full premium amount is the obligation of the head of household of the assistance unit. A family can decide to request healthcare coverage only for certain children in the assistance unit, 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 assistance unit. The premium payment requirement remains the obligation of head of household of the assistance unit. The failure of a sponsor or other third party to pay the premium does not eliminate the:
    1. Establishment of the period of ineligibility described in subsection (7) of this section; or
    2. Obligation of the head of household to pay past-due premiums.