Section R9-31-1419. Premium Payment During the Appeal and Request for Hearing Process

A.      Discontinuance of eligibility. To receive coverage from the time an appeal and request for hearing is filed for a discontinu- ance of eligibility until a Director’s decision is made.

1.        A member shall:

a.         File an appeal and request for hearing prior to the effective date of the discontinuance.

b.        Submit the full monthly premium amount to the Administration prior to the date of the discontinu- ance, and

c.         Continue to pay the full monthly premium amount each month during the hearing process.

2.        Failure of the member to pay the full premium shall result in the loss of eligibility effective the first of the next month.

3.        If the decision is upheld, the Administration shall not refund any premium amounts that have been paid during the hearing process.

B.       Increase in premium amount. To stop the Administration from increasing the premium amount from the time an appeal and request for hearing is filed until a Director’s decision is made.

1.        A member shall file an appeal and request for hearing prior to the effective date of the action. The member shall pay the lower premium amount until the decision is made.

2.        If the decision to increase the premium is upheld, the member shall be responsible for paying the higher pre- mium retroactively from the proposed effective date of the increase in the premium amount that is being appealed.

C.      Imposition of a premium. To receive coverage from the time an appeal and request for hearing is filed for an imposition of a premium until a Director’s decision is made.

1.        A member shall file an appeal and request for hearing in accordance with the time-frame as specified in R9-34- 107.

2.        A member shall pay the premium as billed by the Admin- istration.

3.        If the decision determines the imposition of the premium is incorrect then the premium will be refunded to the member.

D.      Method of payment. To continue coverage a member shall pay the premium by:

1.        Cashier’s check,

2.        Money order, or

3.        Other form approved by the Administration.

Historical Note

New Section made by exempt rulemaking at 8 A.A.R. 5007, effective January 1, 2003 (Supp. 02-4). Amended by exempt rulemaking at 11 A.A.R. 477, effective Janu- ary 1, 2005 (Supp. 04-4).