DHS 109.13(2)(a)3.3. The person is a member of a fiscal test group with an annual income greater than 240% of the poverty line for a family the size of the fiscal test group and has met both of the following thresholds during the current benefit period, in the following order: DHS 109.13(2)(b)(b) Copayment. Except as provided under sub. (3) (e), a person receiving the SeniorCare prescription benefit may purchase prescription drugs from participating SeniorCare providers for one of the following copayment amounts: DHS 109.13(2)(b)1.1. A copayment of $5 for each prescription drug that bears only a generic name. DHS 109.13(2)(b)2.2. A copayment of $15 for each prescription drug that does not bear only a generic name. DHS 109.13(2)(bm)(bm) Exclusion of copayment. A copayment is not required for a vaccine or vaccine administration. DHS 109.13(2)(c)(c) Exclusion for drugs. If a drug is covered by a third party and the participant makes a copayment to the SeniorCare provider, the department is not responsible for refunding the copayment amount to the participant. DHS 109.13(2)(d)(d) Exclusion for vaccines and vaccine administration. The department will not cover reimbursement of a vaccine or vaccine administration in any of the following circumstances: DHS 109.13(2)(d)1.1. A vaccine is not on the federal centers for disease control and prevention’s advisory committee on immunization practices list of vaccines recommended for immunization to adults. DHS 109.13(2)(d)2.2. A vaccine is not administered by a SeniorCare provider in an allowed place of service. DHS 109.13(2)(e)(e) Exclusion for vaccines. The department will not cover reimbursement of a vaccination when the vaccine is allocated through the federal government at no cost to the provider. DHS 109.13(3)(a)(a) Income category applicability. A person may receive the SeniorCare benefit and services under par. (b) under any of the following conditions: DHS 109.13(3)(a)1.1. The person is a member of a fiscal test group with an annual income greater than 160%, but not in excess of 240% of the poverty line for a family the size of the fiscal test group. DHS 109.13(3)(a)2.2. The person is a member of a fiscal test group with an annual income greater than 240% of the federal poverty line for a family the size of the fiscal test group, but only for the remainder of the benefit period after he or she has met the spend-down as described in sub. (4) (c). DHS 109.13(3)(b)1.1. Except as provided under sub. (4) (d), a person receiving the SeniorCare deductible benefit and services may purchase prescription drugs from participating SeniorCare providers at the program payment rate. DHS 109.13(3)(b)2.2. The department shall maintain a record of the prescription drug purchases of each person receiving the SeniorCare deductible services and shall inform participating SeniorCare providers when the person receiving the SeniorCare deductible benefits and services has met the deductible within the benefit period as described in par. (d). DHS 109.13(3)(c)(c) Amount. The amount of the SeniorCare deductible is based on a fiscal test group’s income as a percentage of the federal poverty line for a family the size of the fiscal test group, as follows: DHS 109.13(3)(c)1.1. If the fiscal test group’s income is more than 160% of the federal poverty line, but not more than 200%, the deductible is $500. DHS 109.13(3)(c)2.2. If the fiscal test group’s income is more than 200% of the federal poverty line, the deductible is $850. DHS 109.13(3)(d)(d) Meeting the deductible. The deductible is considered met and the person shall receive the prescription benefit under sub. (2) (b) when, under the following conditions, the person has spent the dollar amount specified in par. (c) in purchasing prescription drugs: DHS 109.13(3)(d)1.1. Only purchases of prescription drugs prescribed for the eligible individual count toward meeting the deductible. DHS 109.13(3)(d)2.2. Each spouse has a deductible. When both persons in a 2-person fiscal test group are eligible for SeniorCare, each person’s purchases of prescription drugs shall only be counted toward meeting the deductible of the person for whom the drugs are prescribed. DHS 109.13(3)(d)3.3. Only prescription drugs dispensed with a date of service during the current benefit period described in s. DHS 109.14 may count toward meeting the deductible. DHS 109.13(3)(d)4.4. If a person has other available coverage from any third party insurer legally liable to contribute in whole or in part to the cost of prescription drugs provided to a SeniorCare participant, including coverage by a county relief program under ch. 49, Stats., only costs for prescription drugs for the person that are not paid under the person’s other available coverage may count toward meeting the deductible. DHS 109.13(3)(d)6.6. Only claims submitted by a SeniorCare provider shall be considered in determining whether or not the participant has met the deductible.