Health Planning Council of Southwest Florida, Ryan White Part B
Health Insurance PolicyRevised 3/19/2014
Eligible RW clients with existing health insurance policies must apply for the ADAP Premium Plus Insurance Program (formerly AICP). ADAP Premium Plus Insurance Program will assist with insurance premiums up to $750 per month, ADAP formulary medications, and $2,500 a year for insurance deductibles. Additionally The Health Planning Council of Southwest Florida has included Health Insurance in the Area 8 budget. As long as funding allows, Area 8 clients will provide services according to the policies below:
- RW Part B Funds can be accessed for persons on the waitlist:
- Up to $750 a month for persons currentlyapplying to ADAP Premium Plus Insurance and placed on the waitlist until they are accepted into the ADAP Premium Plus Insurance program.
- RW Part B Fundscan be accessed forindividuals who (i) applied and have been denied, (ii) have applied and are waiting for a response, or (iii) have screened out of ADAP Premium Plus Insurance program:
- Up to $500 a month for insurance premiums.
In order to access this you must submit the following:
- Documentation of reason of denial for ADAP Premium Plus Insurance program.
- Submission of the cost effective Insurance Screening Tool.
- Up to $100 per month for either Medical co-payments and/ or the existing Area 8 Formulary co-payments.
- Up to a $500.00 toward Deductible.
- RW B Fund Funds can be accessed for individuals who purchase ACA Marketplace Plans:
- Up to $500 a month for insurance premiums.
In order to access this you must submit the following:
- Submission of the cost effective Insurance Screening Tool.
- An AICP denial is not required as the program is currently denying ACA plans as policy. This will likely change at some point during this year.
- Up to $100 per month for either Medical co-payments and/ or the existing Area 8 Formulary co-payments.
- Up to a $500.00 toward Deductible.
- Additional requirements in order to access RW funds for ACA plans.
- The ACA plan must be a Silver, Gold or Platinum Plan with a formulary that includes any HIV/AIDS medications that the client has been prescribed.
- Clients must apply for and accept the advanced premium tax credit and any cost sharing price reductionsdue to income level if eligible.
4. RW Part B Funds can be accessed for persons in the ADAP PREMIUM PLUS INSURANCEprogram:
a. Up to $250 a month toward insurance premiums for individuals who have policies that are greater than ADAP PREMIUM PLUS INSURANCE will cover.
b. Drug co-payments of up to $100 total per month for medication on the Area 8 Formulary.
RW Part B Funds cannot be used for:
- Deductible for clients enrolled in the ADAP Premium Plus Insurance program.
- Medicare, Medicaid or other federal or state funded clinical visit or prescription co-payments.
Documentation:HPCSWF will requirea Premium invoice in order to process requests.
Co-payments will be paid using an original physician or pharmacy invoice and an accompanying Explanation of Benefits (EOB).
I, (print client name) ______, have read and understand the above policy. I understand my responsibilities to seek other sources of reimbursement or coverage, and seek reimbursement back to the RW Part B program where applicable. I understand I must be compliant with the requirements for assistance outlined above or I risk being ineligible for further assistance.
Client Signature: ______Date: ______
Case Manager: ______Date: ______