Florida Regulations 64D-4.007: AIDS Drug Assistance Program (ADAP)
Current as of: 2024 | Check for updates
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(1) To participate in the AIDS Drug Assistance Program an individual must be determined eligible as defined in Fl. Admin. Code R. 64D-4.003
(2) To receive ADAP Premium Plus Insurance Program benefits, participants must be deemed eligible according to subsection (1), above, and:
(a) Use the ADAP contracted insurance benefits manager to enroll in an ADAP approved plan to receive insurance premium assistance.
(b) Need insurance policy pharmaceutical coverage to the extent that payment cannot be made or cannot reasonably be expected to be made by another payer source.
(c) Use an ADAP contracted pharmacy(ies) to receive premium assistance, medications co-payment and/or deductible.
(3) To receive ADAP insurance benefits for plans purchased through the federally facilitated Marketplace, participants must be deemed eligible according to subsection (1) above; meet the ADAP Premium Plus Insurance Program requirements in subsection (2) above; and comply with the following requirements:
(a) Determination of available subsidies must be requested when submitting a Marketplace application. If an individual qualifies for a premium tax credit, the individual must select the advanced premium tax credit that is paid directly to the insurance provider.
(b) All supporting documentation submitted to the Marketplace as part of the application and/or enrollment process must also be submitted to ADAP.
Rulemaking Authority Florida Statutes § 381.0011(2), 381.003(2) FS. Law Implemented 381.0011, 381.003(1)(b) FS. History-New 7-4-16, Amended 4-5-21, 11-1-22.
(a) Use the ADAP contracted insurance benefits manager to enroll in an ADAP approved plan to receive insurance premium assistance.
(b) Need insurance policy pharmaceutical coverage to the extent that payment cannot be made or cannot reasonably be expected to be made by another payer source.
(c) Use an ADAP contracted pharmacy(ies) to receive premium assistance, medications co-payment and/or deductible.
(3) To receive ADAP insurance benefits for plans purchased through the federally facilitated Marketplace, participants must be deemed eligible according to subsection (1) above; meet the ADAP Premium Plus Insurance Program requirements in subsection (2) above; and comply with the following requirements:
(a) Determination of available subsidies must be requested when submitting a Marketplace application. If an individual qualifies for a premium tax credit, the individual must select the advanced premium tax credit that is paid directly to the insurance provider.
(b) All supporting documentation submitted to the Marketplace as part of the application and/or enrollment process must also be submitted to ADAP.
Rulemaking Authority Florida Statutes § 381.0011(2), 381.003(2) FS. Law Implemented 381.0011, 381.003(1)(b) FS. History-New 7-4-16, Amended 4-5-21, 11-1-22.