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Premiums
Q: Under the benchmark plan, if parents don't pay their premium, they will
be sanctioned for six months. Will this affect the children's medical
coverage?
A: No, the failure to pay a premium does not affect the eligibility of any
person in the household who does not have a premium obligation. If an
individual or family with a premium obligation fails to pay the premium by the
last day of the month that a premium is due, benefits will close for those
individuals who owed a premium. Those individual(s) are not eligible for six
calendar months following the date on which their coverage terminated, unless
there was good cause for the non-payment.
Q: I am confused about the cap on premiums. The handbook does not state
anything about $68.25 cap, only the 5% cap. So, which is it? It looks like the
calculation will be done at the 5% rate cap. So, is the $68.25 amount
misleading? (reference 19.2, 19.3)
A: Individual premiums for children will have a set amount per child per month,
based on family income. The original estimate for a maximum amount per child was
$68.25, which would be for a family with an income at 300% of poverty and
higher. The estimated maximum premium amount has increased to $90.74 per month.
Families with incomes not exceeding 300% of FPL will never have to pay more than
5% of their family income for BC+ premiums, no matter how many children they
have covered by BC+.
Q: Is there a maximum premium that a family will have to pay?
A: For families with incomes below 300% of FPL, premiums will not exceed 5% of
the family’s countable income.
Q: Once a member is enrolled in Badger Care Plus, if they do not pay their
premiums how long do they have before they are kicked off ?
A: The members who owe premium payments must make the payment in the month the
payment is due. If a family owes a premium for the month of February, but does not
pay in February, they
will be ineligible for BC+ benefits for March.
Q: How do they regain benefits?
A: Using the example above, if they pay their premiums before the end of March,
they could be eligible for March. However, they would also have to pay their
February and March premiums before they could get coverage.
Q: How long do they need to wait before they are eligible again?
A: Using the same example as above, if they do not pay within 30 days of their
benefits ending (e.g., by the end of March) they are ineligible for a 6-month
period (e.g., until September). After the end of the 6-month restrictive
reenrollment period, they have to pay any outstanding payments owed before
becoming eligible. There are two exceptions to this policy.
- If the family’s income drops to a point where the ineligible
persons no longer owe a premium, they could get BC+.
- If a family does not receive BC+ for 12 months following the non-payment of premiums, they no longer have to
pay the outstanding amounts.
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