Common use of POWER Account Roll Over Clause in Contracts

POWER Account Roll Over. Where a member has funds remaining at the end of the calendar year benefit period, some of the funds remaining in the member’s POWER Account may be rolled over into the next calendar year benefit period for purposes of reducing the member’s required HIP Plus or HIP State Plan Plus POWER Account contributions. Only member rollover dollars can be applied to the tobacco surcharge. Roll over is applied to the member’s new account 121 days following the end of the calendar year benefit period. The amount of leftover funds available for roll over will depend on the member’s contributions to the POWER Account, the balance remaining in the member’s POWER Account, any member debt, and the member’s receipt of recommended preventive care services. For each benefit period, OMPP will determine, based on Centers for Disease Control recommendations, which recommended preventive care services apply to a specific member’s age and gender, as well as the member’s pre-existing conditions. POWER Accounts are designed to encourage preventive care, the appropriate utilization of health care services and personal responsibility. The Contractor shall develop multiple methods of emphasizing to members that responsible use of POWER Account funds, as well as obtaining recommended preventive care services, can lead to a reduced financial burden in the next benefit period. If members are aware that prudent management of their health care expenditures can leave them with available funds at the end of the calendar year benefit period—and that these funds can be used to lower their contribution requirements for the following benefit period— members will be encouraged to make value- and cost- conscious decisions. See Section 7.4.4 for required POWER Account member education responsibilities. The Contractor may collect any member debt from the member portion of roll- over funds determined in accordance with the roll-over calculations detailed in Sections 5.6.2.1 and 5.6.2.2. Under no circumstances shall State roll-over funds be used to pay member debt. In collecting member debt from roll-over funds, the Contractor shall comply with the specific calculations established in the HIP MCE Policies and Procedures Manual. 5.8.2.1 HIP Plus Roll-Over HIP Plus members and HIP State Plan Plus members who consistently contribute to their POWER account during the calendar year benefit period will be eligible to roll-over the member’s unused pro rata share of the POWER Account balance. If a HIP Plus member or HIP State Plan Plus member receives any recommended preventive care service during the calendar year benefit period, the member will be eligible to have their unused share, or “roll-over amount”, doubled by the State as an added incentive. Depending on the balance in the POWER Account, this roll-over amount may significantly reduce or even eliminate the member’s required contributions in future benefit periods. Any remaining State funds shall be credited back to the State. The roll-over amounts for HIP Plus members and HIP State Plan Plus members are calculated as follows: 1. First, the member’s portion of the remaining POWER Account balance (the Member Share) is determined by the following formula: Divide the sum of member incurred month POWER account contributions by 2,500 (the fully funded POWER account total) 2. Second, the Base Roll-Over Amount is determined as follows: Member Share (from #1) multiplied by the claims paid from the POWER account. This is the member’s claims responsibility for the year. Any payments made by the member in excess of their claims responsibility can be rolled over to the next calendar year. Subtract this from the sum of required monthly contributions paid by the member. Where the result is positive this is the member’s Base Rollover Amount. Where the result is negative the member has debt. 3. Finally, the Final Roll-Over Amount is determined based on whether the member obtained recommended preventive services. The preventive services bonus is applied to the Base Roll-Over Amount as follows to determine the Final Roll-Over Amount: If preventive services are completed during the plan year: Base Roll-Over Amount x 2 = Final Roll- Over Amount If preventive services are not completed during the plan year: Base Roll-Over Amount x 1 = Final Roll- Over Amount Consider the following example: A member who contributes $120.00 over 12 months of enrollment ($10 per month) to the POWER Account over the course of a benefit period and the State contributes $2,380 for a combined contribution of $2,500 ($120 + $2,380 = $2,500). Under the scenario, the member’s pro rata share of the total POWER Account is .048 (120/2500). The member spends $2,100 of POWER Account funds to pay for covered services during the benefit period. At the end of the benefit period, $400 remains in the member’s POWER Account (2,500 - $2,100 = $400).

POWER Account Roll Over. Where a member has funds remaining at the end of the calendar year benefit period, some of the funds remaining in the member’s POWER Account may be rolled over into the next calendar year benefit period for purposes of reducing the member’s required HIP Plus or HIP State Plan Plus POWER Account contributions. Only member rollover dollars can be applied to the tobacco surcharge. Roll over is applied to the member’s new account 121 days following the end of the calendar year benefit period. The amount of leftover funds available for roll over will depend on the member’s contributions to the POWER Account, the balance remaining in the member’s POWER Account, any member debt, and the member’s receipt of recommended preventive care services. For each benefit period, OMPP will determine, based on Centers for Disease Control recommendations, which recommended preventive care services apply to a specific member’s age and gender, as well as the member’s pre-existing conditions. POWER Accounts are designed to encourage preventive care, the appropriate utilization of health care services and personal responsibility. The Contractor shall develop multiple methods of emphasizing to members that responsible use of POWER Account funds, as well as obtaining recommended preventive care services, can lead to a reduced financial burden in the next benefit period. If members are aware that prudent management of their health care expenditures can leave them with available funds at the end of the calendar year benefit period—and that these funds can be used to lower their contribution requirements for the following benefit period— members will be encouraged to make value- and cost- cost-conscious decisions. See Section 7.4.4 for required POWER Account member education responsibilities. The Contractor may collect any member debt from the member portion of roll- roll-over funds determined in accordance with the roll-over calculations detailed in Sections 5.6.2.1 and 5.6.2.2. Under no circumstances shall State roll-over funds be used to pay member debt. In collecting member debt from roll-over funds, the Contractor shall comply with the specific calculations established in the HIP MCE Policies and Procedures Manual. 5.8.2.1 HIP Plus Roll-Over HIP Plus members and HIP State Plan Plus members who consistently contribute to their POWER account during the calendar year benefit period will be eligible to roll-over the member’s unused pro rata share of the POWER Account balance. If a HIP Plus member or HIP State Plan Plus member receives any recommended preventive care service during the calendar year benefit period, the member will be eligible to have their unused share, or “roll-over amount”, doubled by the State as an added incentive. Depending on the balance in the POWER Account, this roll-over amount may significantly reduce or even eliminate the member’s required contributions in future benefit periods. Any remaining State funds shall be credited back to the State. The roll-over amounts for HIP Plus members and HIP State Plan Plus members are calculated as follows: 1. First, the member’s portion of the remaining POWER Account balance (the Member Share) is determined by the following formula: Divide the sum of member incurred month POWER account contributions by 2,500 (the fully funded POWER account total) 2. Second, the Base Roll-Over Amount is determined as follows: Member Share (from #1) multiplied by the claims paid from the POWER account. This is the member’s claims responsibility for the year. Any payments made by the member in excess of their claims responsibility can be rolled over to the next calendar year. Subtract this from the sum of required monthly contributions paid by the member. Where the result is positive this is the member’s Base Rollover Amount. Where the result is negative the member has debt. 3. Finally, the Final Roll-Over Amount is determined based on whether the member obtained recommended preventive services. The preventive services bonus is applied to the Base Roll-Over Amount as follows to determine the Final Roll-Over Amount: If preventive services are completed during the plan year: Base Roll-Over Amount x 2 = Final Roll- Over Amount If preventive services are not completed during the plan year: Base Roll-Over Amount x 1 = Final Roll- Over Amount Consider the following example: A member who contributes $120.00 over 12 months of enrollment ($10 per month) to the POWER Account over the course of a benefit period and the State contributes $2,380 for a combined contribution of $2,500 ($120 + $2,380 = $2,500). Under the scenario, the member’s pro rata share of the total POWER Account is .048 (120/2500). The member spends $2,100 of POWER Account funds to pay for covered services during the benefit period. At the end of the benefit period, $400 remains in the member’s POWER Account (2,500 - $2,100 = $400).and

POWER Account Roll Over. Where a member has funds remaining at the end of the calendar year benefit period, some of the funds remaining in the member’s POWER Account may be rolled over into the next calendar year benefit period for purposes of reducing the member’s required HIP Plus or HIP State Plan Plus POWER Account contributions. Only member rollover dollars can be applied to the tobacco surcharge. Roll over is applied to the member’s new account 121 days following the end of the calendar year benefit period. The amount of leftover funds available for roll over will depend on the member’s contributions to the POWER Account, the balance remaining in the member’s POWER Account, any member debt, and the member’s receipt of recommended preventive care services. For each benefit period, OMPP will determine, based on Centers for Disease Control recommendations, which recommended preventive care services apply to a specific member’s age and gender, as well as the member’s pre-existing conditions. POWER Accounts are designed to encourage preventive care, the appropriate utilization of health care services and personal responsibility. The Contractor shall develop multiple methods of emphasizing to members that responsible use of POWER Account funds, as well as obtaining recommended preventive care services, can lead to a reduced financial burden in the next benefit period. If members are aware that prudent management of their health care expenditures can leave them with available funds at the end of the calendar year benefit period—and that these funds can be used to lower their contribution requirements for the following benefit period— members will be encouraged to make value- and cost- cost-conscious decisions. See Section 7.4.4 for required POWER Account member education responsibilities. The Contractor may collect any member debt from the member portion of roll- over funds determined in accordance with the roll-over calculations detailed in Sections 5.6.2.1 and 5.6.2.2. Under no circumstances shall State roll-over funds be used to pay member debt. In collecting member debt from roll-over funds, the Contractor shall comply with the specific calculations established in the HIP MCE Policies and Procedures Manual. 5.8.2.1 HIP Plus Roll-Over HIP Plus members and HIP State Plan Plus members who consistently contribute to their POWER account during the calendar year benefit period will be eligible to roll-over the member’s unused pro rata share of the POWER Account balance. If a HIP Plus member or HIP State Plan Plus member receives any recommended preventive care service during the calendar year benefit period, the member will be eligible to have their unused share, or “roll-over amount”, doubled by the State as an added incentive. Depending on the balance in the POWER Account, this roll-over amount may significantly reduce or even eliminate the member’s required contributions in future benefit periods. Any remaining State funds shall be credited back to the State. The roll-over amounts for HIP Plus members and HIP State Plan Plus members are calculated as follows: 1. First, the member’s portion of the remaining POWER Account balance (the Member Share) is determined by the following formula: Divide the sum of member incurred month POWER account contributions by 2,500 (the fully funded POWER account total) 2. Second, the Base Roll-Over Amount is determined as follows: Member Share (from #1) multiplied by the claims paid from the POWER account. This is the member’s claims responsibility for the year. Any payments made by the member in excess of their claims responsibility can be rolled over to the next calendar year. Subtract this from the sum of required monthly contributions paid by the member. Where the result is positive this is the member’s Base Rollover Amount. Where the result is negative the member has debt. 3. Finally, the Final Roll-Over Amount is determined based on whether the member obtained recommended preventive services. The preventive services bonus is applied to the Base Roll-Over Amount as follows to determine the Final Roll-Over Amount: If preventive services are completed during the plan year: Base Roll-Over Amount x 2 = Final Roll- Over Amount If preventive services are not completed during the plan year: Base Roll-Over Amount x 1 = Final Roll- Over Amount Consider the following example: A member who contributes $120.00 over 12 months of enrollment ($10 per month) to the POWER Account over the course of a benefit period and the State contributes $2,380 for a combined contribution of $2,500 ($120 + $2,380 = $2,500). Under the scenario, the member’s pro rata share of the total POWER Account is .048 (120/2500). The member spends $2,100 of POWER Account funds to pay for covered services during the benefit period. At the end of the benefit period, $400 remains in the member’s POWER Account (2,500 - $2,100 = $400).

POWER Account Roll Over. Where a member has funds remaining at the end of the calendar year benefit period, some of the funds remaining in the member’s POWER Account may be rolled over into the next calendar year benefit period for purposes of reducing the member’s required HIP Plus or HIP State Plan Plus POWER Account contributions. Only member rollover dollars can be applied to the tobacco surcharge. Roll over is applied to the member’s new account 121 days following the end of the calendar year benefit period. The amount of leftover funds available for roll over will depend on the member’s contributions to the POWER Account, the balance remaining in the member’s POWER Account, any member debt, and the member’s receipt of recommended preventive care services. For each benefit period, OMPP will determine, based on Centers for Disease Control recommendations, which recommended preventive care services apply to a specific member’s age and gender, as well as the member’s pre-existing conditions. POWER Accounts are designed to encourage preventive care, the appropriate utilization of health care services and personal responsibility. The Contractor shall develop multiple methods of emphasizing to members that responsible use of POWER Account funds, as well as obtaining recommended preventive care services, can lead to a reduced financial burden in the next benefit period. If members are aware that prudent management of their health care expenditures can leave them with available funds at the end of the calendar year benefit period—and that these funds can be used to lower their contribution requirements for the following benefit period— —members will be encouraged to make value- and cost- cost-conscious decisions. See Section 7.4.4 for required POWER Account member education responsibilities. The Contractor may collect any member debt from the member portion of roll- roll-over funds determined in accordance with the roll-over calculations detailed in Sections 5.6.2.1 and 5.6.2.2. Under no circumstances shall State roll-over funds be used to pay member debt. In collecting member debt from roll-over funds, the Contractor shall comply with the specific calculations established in the HIP MCE Policies and Procedures Manual. 5.8.2.1 HIP Plus Roll-Over HIP Plus members and HIP State Plan Plus members who consistently contribute to their POWER account during the calendar year benefit period will be eligible to roll-over the member’s unused pro rata share of the POWER Account balance. If a HIP Plus member or HIP State Plan Plus member receives any recommended preventive care service during the calendar year benefit period, the member will be eligible to have their unused share, or “roll-over amount”, doubled by the State as an added incentive. Depending on the balance in the POWER Account, this roll-over amount may significantly reduce or even eliminate the member’s required contributions in future benefit periods. Any remaining State funds shall be credited back to the State. The roll-over amounts for HIP Plus members and HIP State Plan Plus members are calculated as follows: 1. First, the member’s portion of the remaining POWER Account balance (the Member Share) is determined by the following formula: Divide the sum of member incurred month POWER account contributions by 2,500 (the fully funded POWER account total) 2. Second, the Base Roll-Over Amount is determined as follows: Member Share (from #1) multiplied by the claims paid from the POWER account. This is the member’s claims responsibility for the year. Any payments made by the member in excess of their claims responsibility can be rolled over to the next calendar year. Subtract this from the sum of required monthly contributions paid by the member. Where the result is positive this is the member’s Base Rollover Amount. Where the result is negative the member has debt. 3. Finally, the Final Roll-Over Amount is determined based on whether the member obtained recommended preventive services. The preventive services bonus is applied to the Base Roll-Over Amount as follows to determine the Final Roll-Over Amount: If preventive services are completed during the plan year: Base Roll-Over Amount x 2 = Final Roll- Over Amount If preventive services are not completed during the plan year: Base Roll-Over Amount x 1 = Final Roll- Over Amount Consider the following example: A member who contributes $120.00 over 12 months of enrollment ($10 per month) to the POWER Account over the course of a benefit period and the State contributes $2,380 for a combined contribution of $2,500 ($120 + $2,380 = $2,500). Under the scenario, the member’s pro rata share of the total POWER Account is .048 (120/2500). The member spends $2,100 of POWER Account funds to pay for covered services during the benefit period. At the end of the benefit period, $400 remains in the member’s POWER Account (2,500 - $2,100 = $400).and