Healthcare for workers with disabilities (HWD) -- Premium payments.
Effective November 21, 2011
This section describes how the department calculates the premium amount a person must pay for healthcare for workers with disabilities (HWD) coverage. This section also describes program requirements regarding the billing and payment of HWD premiums.
1. When determining the HWD premium amount, the department counts only the income of the person approved for the program. It does not count the income of another household member.
2. When determining countable income used to calculate the HWD premium, the department applies the following rules:
a. Income is considered available and owned when it is:
i. Received; and
ii. Can be used to meet the person's needs for food, clothing, and shelter, except as described in WAC 388-475-0600 (5), 388-475-0650, and 388-475-0700 (1).
b. Loans and certain other receipts are not considered to be income as described in 20 C.F.R. Sec. 416.1103, e.g., direct payment by anyone of a person's medical insurance premium or a tax refund on income taxes already paid.
3. The HWD premium amount equals a total of the following (rounded down to the nearest whole dollar):
a. Fifty percent of unearned income above the medically needy income level (MNIL) described in WAC 388-478-0070; plus
b. Five percent of total unearned income; plus
c. Two point five percent of earned income after first deducting sixty-five dollars.
4. When determining the premium amount, the department will use the current income amount until a change in income is reported and processed.
5. A change in the premium amount is effective the month after the change in income is reported and processed.
6. For current and ongoing coverage, the department will bill for HWD premiums during the month following the month in which coverage is approved.
7. For retroactive coverage, the department will bill the HWD premiums during the month following the month in which coverage is requested and necessary information is received.
8. If initial coverage for the HWD program is approved in a month that follows the month of application, the first monthly premium includes the costs for both the month of application and any following month(s).
9. As described in WAC 388-475-1050 (4)(b), the department will close HWD coverage after four consecutive months for which premiums are not paid in full.
10. If a person makes only a partial payment toward the cost of HWD coverage for any one month, the person remains one full month behind in the payment schedule.
11. The department first applies payment for current and ongoing coverage to any amount owed for such coverage in an earlier month. Then it applies payment to the current month and then to any unpaid amount for retroactive coverage.