(a) Out-of-pocket medical expenses for all approved and eligible members (and/or their approved and eligible dependents) will be limited to 5 percent of their annual gross household income.  The OHCA will provide reimbursement for out-of-pocket medical expenses in excess of the 5 percent annual gross household income.  A medical expense must be for an allowed and covered service by a qualified health plan to be eligible for reimbursement.  For the purpose of this Section, an allowed and covered service is defined as an in-network service covered in accordance with a qualified health plan's benefit summary and policies.

(b) For all eligible medical expenses as defined above in OAC 317:45-1-4(a), the member must submit the OHCA required form and all OHCA required documentation to support that the member incurred and paid the out-of-pocket medical expense.  The required documentation must be submitted no later than 90 days after the close of the member's eligibility period.  The OHCA required documentation must substantiate that the member actually incurred and paid the eligible out-of-pocket expense.  The OHCA may request additional documentation at any time to support a member's request for reimbursement of eligible out-of-pocket medical expenses.