Utah Admin. Code R382-10-4 - Applicant and Enrollee Rights and Responsibilities
(1) A parent or an adult who assumes
responsibility for the care or supervision of a child may apply or reapply for
CHIP benefits on behalf of a child. A child who is independent may apply on the
child's own behalf.
(2) If a person
needs assistance to apply, the person may request assistance from a friend,
family member, the eligibility agency, or outreach staff.
(3) The applicant must provide verification
requested by the eligibility agency to establish the eligibility of the child,
including information about the parents.
(4) Anyone may look at the eligibility policy
manuals located online or at any eligibility agency office that is not an
outreach or telephone-only location.
(5) If the eligibility agency determines that
the child received CHIP coverage during a period when the child was not
eligible for CHIP, the parent, child, or legal guardian who arranges for
medical services on behalf of the child must repay the department for the cost
of services.
(6) The parent or
child, or other responsible person acting on behalf of a child, must report
certain changes to the eligibility agency.
(a)
The following changes are reportable within ten calendar days of the day of the
change:
(i) the member begins to receive
coverage or to have access to coverage under a group health plan or other
health insurance coverage;
(ii) the
member leaves the household or dies;
(iii) the member or the household moves out
of state;
(iv) the member or the
household changes address; and
(v)
the member enters a public institution or an institution for mental
disease.
(b) Certain
changes are reportable as part of the review process if these changes occurred
anytime during the certification period and before the 10-day notice due date
in the review month. The member must report a change in the following as part
of the review process for any household member:
(i) income source;
(ii) gross income of $25 or more;
(iii) tax filing status;
(iv) pregnancy or termination of a
pregnancy;
(v) number of dependents
claimed as tax dependents;
(vi)
earnings of a child;
(vii) marital
status; and
(viii) student status
of a child under 24 years of age.
(7) An applicant and a member may review the
information that the eligibility agency uses to determine
eligibility.
(8) An applicant and a
member have the right to be notified about actions that the agency takes to
determine the applicant's or member's eligibility or continued eligibility, the
right to be notified about the reason the action was taken, and the right to
request an agency conference or agency action as defined in Section R414-301-6
and Section R414-301-7.
(9) A CHIP
member must pay copayments or coinsurance amounts to providers for medical
services that the member receives under CHIP.
Notes
State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.
No prior version found.