Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 100 - STATE PROGRAMS › Part III - HIV Premium Assistance Program › Section 12VAC30-100-250 - Definitions

Current through Register Vol. 40, No. 24, July 15, 2024
"Appeal" means the process by which an applicant or
					 enrollee in the HIV Premium Assistance Program can obtain a review of a
					 decision, action, or failure to act on the part of the program.
"Applicant" means an individual who has applied for or is
					 in the process of applying for HIV Premium Assistance Program benefits.
"Applicant's representative" means a person who, because of
					 the applicant's or enrollee's mental or physical incapacity or standing as a
					 child, is permitted to act, complete, sign, or withdraw an application for the
					 benefits of the program; activate the appeal process; and otherwise supply any
					 information requested by the program on behalf of the applicant or
					 enrollee.
"Child" means an unmarried person younger than 18 years of
					 age and who lives with a parent or legal guardian.
"Date of application" means the date that an application is
					 officially received by the program.
"Department" or "DMAS" means the Virginia Department of
					 Medical Assistance Services which has administrative authority and
					 responsibility for the program.
"Enrollee" means an individual who has been determined to
					 be eligible for and is receiving assistance from the program.
"Family" means:
1.
				  The applicant or enrollee,
2. The
				  applicant or enrollee's spouse,
3.
				  The applicant's or enrollee's children who are under 21 years if the children
				  live with the applicant,
4. When
				  the applicant or enrollee is a child:
a. The
				  applicant's parent or parents,
b.
				  The minor applicant's unmarried siblings under 21 years, at the option of the
				  applicant's or enrollee's parents.
"Group health insurance plan" means a plan which meets
					 § 5000(b)(1) of the Internal Revenue Code of 1986, as amended, includes
					 continuation coverage pursuant to Title XXII of the Public Health Services Act,
					 § 4980B of the Internal Revenue Code of 1986, or Title VI of the Employee
					 Retirement Income Security Act of 1974, and is consistent with the provisions
					 of the Consolidated Omnibus Budget Reconciliation Act of 1985, Public Law
					 99-272 and any subsequent modifications to the Act. Section 5000(b)(1) of the
					 Internal Revenue Code provides that a group health plan is any plan of, or
					 contributed to by, an employer (including a self-insured plan) to provide
					 health care (directly or otherwise) to the employer's employees, former
					 employees, or the families of such employees or former employees.
"Health insurance premiums" or "premiums" means the health
					 insurance premiums paid by or on behalf of an individual in order to obtain or
					 maintain health insurance plan benefits.
"HIV positive" means a positive diagnosis of infection with
					 the human immune deficiency virus (HIV) as determined by the enzyme-linked
					 immunosorbent assay (ELISA) and confirmed by the Western Blot, or another
					 generally accepted diagnostic test for HIV infection.
"HIV Premium Assistance Program" or "the program" means the
					 Virginia program that provides payment of health insurance premiums under
					 certain circumstances to individuals who are HIV positive, in accordance with
					 the provision of the Consolidated Omnibus Budget Reconciliation Act of 1985,
					 Public Law 99-272 and any subsequent modifications to the Act and as authorized
					 by § 32.1-330.1 of the Code of Virginia.
"Medicaid" means the state-federal medical assistance
					 program of comprehensive medical and other health-related care for indigent and
					 medically indigent persons authorized by Title XIX of the Social Security Act
					 and administered by the Virginia Department of Medical Assistance
					 Services.
"Nongroup health insurance plan" means a health insurance
					 plan that is offered to an individual or an individual family unit without
					 being tied to an employer.
"Physician verification" means certification by a licensed
					 physician of medical information regarding an applicant's or enrollee's HIV
					 positive status and inability to work due to the disease or the substantial
					 likelihood that within three months the individual will be too ill to continue
					 working.
"Poverty level" means the official federal poverty income
					 level, as revised annually.