§457.515. Co-payments, coinsurance, deductibles, or similar cost-sharing charges: State plan requirements.
42 C.F.R. § 457.515
To impose copayments, coinsurance, deductibles or similar charges on enrollees, the State plan must describe—
The service for which the charge is imposed;
The amount of the charge;
The group or groups of enrollees that may be subject to the cost-sharing charge;
The consequences for an enrollee who does not pay a charge, and the disenrollment protections adopted by the State in accordance with § 457.570;
The methodology used to ensure that total cost-sharing liability for a family does not exceed the cumulative cost-sharing maximum specified in § 457.560; and
An assurance that enrollees will not be held liable for cost-sharing amounts for emergency services that are provided at a facility that does not participate in the enrollee's managed care network beyond the copayment amounts specified in the State plan for emergency services as defined in § 457.10.
Notes, amendments, and revision history
Source
Source: 66 FR 2681, Jan. 11, 2001, unless otherwise noted.
Authority
Authority: 42 U.S.C. 1302.
Source
Source: 65 FR 33622, May 24, 2000, unless otherwise noted.