N.J. Admin. Code § 10:49-9.3

Current through Register Vol. 56, No. 21, November 4, 2024

Section 10:49-9.3 - Limitation on cost sharing-Plan C

(a) There shall be a family limit on cost-sharing equal to 5 percent of household income for Plan C beneficiaries.

(b) The cost-sharing limit shall be calculated annually starting with the date of initial enrollment of any children in the family or the annual reenrollment date. For ease of administration, the annual premium should be calculated by the Statewide eligibility determination agency and used to reduce the family cost from the first day of enrollment.

(c) Once the limits have been met, the Statewide eligibility determination agency shall issue a certification indicating that the Plan C member has met their cost share limit, and the provider shall not collect a personal contribution to care until further notice.

(d) No cost sharing shall be imposed on children who are American Indians/Alaska Natives. Proof of Federally recognized AI/AN tribal status shall be provided in the form of a tribal card or letter, in accordance with 42 C.F.R. 36a.16.

N.J. Admin. Code § 10:49-9.3

New Rule, R.1998 d.154, effective 2/27/1998 (operative March 1, 1998; to expire August 31, 1998).
See: 30 New Jersey Register 1060(a).
Former N.J.A.C. 10:49-9.3, Free choice of beneficiary and provider, recodified to N.J.A.C. 10:49-9.6.
Adopted concurrent proposal, R.1998 d.487, effective 8/28/1998.
See: 30 New Jersey Register 1060(a), 30 New Jersey Register 3519(a).
Readopted the provisions of R.1998 d.154 without change.
Amended by R.2002 d.371, effective 11/18/2002.
See: 34 New Jersey Register 2244(a), 34 New Jersey Register 2549(b), 34 New Jersey Register 3978(c).
Added (d).