Ariz. Admin. Code § R2-6-303 - Audit of Dependent Eligibility

A. A member shall not enroll an individual in an insurance plan made available by the Department unless the individual is an eligible dependent as defined in R2-6-101.

B. The Department shall conduct audits to determine whether individuals enrolled by members in an insurance plan made available by the Department are eligible dependents. The Department shall choose a particular member for audit either randomly or in response to uncertainty concerning dependent eligibility.

C. If a member is chosen for audit, the Department shall provide the member with written notice and 60 days in which to produce evidence that an individual enrolled by the member in an insurance plan made available by the Department is an eligible dependent. The Director may extend the 60-day requirement in an individual case. Evidence of dependent eligibility may include one or more of the following:

1. Marriage certificate,

2. Birth certificate,

3. Documentation of lawful presence in the U.S.,

4. Documentation of sharing a permanent residence and financial interdependence as described in R2-6-101(19) ,

5 3. Receipts for insurance payments made while on leave without pay,

6 4. Court order regarding adoption or placement for adoption,

7 5. Court order regarding guardianship,

8 6. Documentation of foster-child placement,

9 7. Tax return,

10. School registration form or transcript,

11 8. Declaration of disability from the Social Security Administration,

12 9. Documentation of Arizona residence, or

13 10. Other documentation acceptable to the Director.

D. If a member chosen for audit fails to produce evidence of dependent eligibility within the time specified in subsection (C), the Department shall:

1. Upon providing advance notice of at least 30 days to the member, terminate insurance coverage of the individual whose eligibility was not proven;

2. Require that the member reimburse the Department for all premiums and claims paid since October 1, 2004, on behalf of the individual whose eligibility was not proven; and

3. Report an employee or officer who misrepresented dependent eligibility to the employee's or officer's agency for possible disciplinary action.

Notes

Ariz. Admin. Code § R2-6-303

Adopted effective September 16, 1997 (Supp. 97-3). Section expired under A.R.S. § 41-1056(E) at 8 A.A.R. 5017, effective September 30, 2002 (Supp. 02-4). New Section made by final rulemaking at 15 A.A.R. 258, effective March 7, 2009 (Supp. 09-1). Amended by final rulemaking at 23 A.A.R. 1719, effective 6/6/2017.