Utah Admin. Code R382-10-10 - Creditable Health Coverage
(1) To be
eligible for enrollment in the program, a child must meet the requirements of
Sections 2110(b) of the Compilation of Social Security Laws.
(2) A child who is covered under a group
health plan or other health insurance that provides coverage in Utah, including
coverage under a parent's or legal guardian's employer, as defined in
29 CFR
2590.701-4, July 1, 2013 ed., is not eligible
for CHIP assistance.
(3) A child
who has access to health insurance coverage, where the cost to enroll the child
in the least expensive plan offered by the employer is less than 5% of the
countable MAGI-based income for the individual, is not eligible for CHIP. The
child is considered to have access to coverage even when the employer only
offers coverage during an open enrollment period, and the child has had at
least one chance to enroll.
(4) An
eligible child who has access to an employer-sponsored health plan, where the
cost to enroll the child in the least expensive plan offered by the employer
equals or exceeds 5% of the countable MAGI-based income for the individual may
choose to enroll in either CHIP or UPP.
(a)
To enroll in UPP, the child must meet UPP eligibility requirements.
(b) If the UPP eligible child enrolls in the
employer-sponsored health plan or COBRA coverage, but the plan does not include
dental benefits, the child may receive dental-only benefits through CHIP.
(c) If the employer-sponsored
health plan or COBRA coverage includes dental, the applicant may choose to
enroll the child in the dental plan and receive an additional reimbursement
from UPP, or receive dental-only benefits through CHIP.
(d) A child enrolled in CHIP who gains access
to or enrolls in an employer-sponsored health plan may switch to the UPP
program if the child meets UPP eligibility requirements.
(5) The cost of coverage include s the
following:
(a) the premium;
(b) a deductible, if the employer-sponsored
plan has a deductible; and
(c) the
cost to enroll the employee, if the employee must be enrolled to enroll the
child.
(6) Subject to
the provisions published in
42
CFR 457.805 (b), October 1, 2015 ed., which
the Department adopts and incorporates by reference, the eligibility agency
shall deny eligibility and impose a 90-day waiting period for enrollment under
CHIP if the applicant or a custodial parent voluntarily terminates health
insurance that provides coverage in Utah within the 90 days before the
application date. In addition, the agency may not apply a 90-day waiting period
in the following situations:
(a) a
non-custodial parent voluntarily terminates coverage;
(b) the child is voluntarily terminated from
insurance that does not provide coverage in Utah;
(c) the child is voluntarily terminated from
a limited health insurance plan;
(d) a child is terminated from a custodial
parent's insurance because ORS reverses the forced enrollment requirement due
to the insurance being unaffordable;
(e) voluntary termination of COBRA;
(f) voluntary termination of Utah
Comprehensive Health Insurance Pool coverage; or
(g) voluntary termination of UPP reimbursed,
employer-sponsored coverage.
(7) If the 90-day ineligibility period for
CHIP ends in the month of application, or by the end of the month that follows,
the eligibility agency shall determine the applicant's eligibility.
(a) If eligible, enrollment in CHIP begins
the day after the 90-day ineligibility period ends.
(b) If the 90-day ineligibility period does
not end by the end of the month that follows the application month, the
eligibility agency shall deny CHIP eligibility.
(8) The Department shall comply with the
provisions of enrollment after the waiting period in accordance with
42 CFR
457.340, October 1, 2015 ed., which the
Department adopts and incorporates by reference.
(9) A child with creditable health coverage
operated or financed by Indian Health Services is not excluded from enrolling
in CHIP.
(10) A child who has
access to state-employee health insurance as defined in
42 CFR
457.310 is not eligible for CHIP assistance.
Notes
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