Utah Admin. Code R590-269-3 - Definitions

Terms used in this rule are defined in Sections 31A-1-301 and 31A-30-103. Additional terms are defined as follows:

(1)

(a) "Loss of minimum essential coverage" means the circumstances described in 26 CFR 54.9801-6(a)(3)(i) through (iii).

(b) "Loss of minimum essential coverage" does not include termination or loss due to:

(i) failure to pay premiums on a timely basis, including COBRA premiums before the expiration of COBRA coverage; or

(ii) a situation allowing for a rescission as specified in 45 CFR 147.128.

(2) "Qualifying life event" means an event that triggers a special enrollment period because an individual or dependent:

(a) loses minimum essential coverage;

(b) gains a dependent or becomes a dependent through marriage, birth, adoption, or placement for adoption;

(c) is unintentionally, inadvertently, or erroneously enrolled or non-enrolled as a result of the error, misrepresentation, or inaction of an officer, employee, or agent of an exchange or the United States Department of Health and Human Services, or its instrumentalities as evaluated and determined by an exchange;

(d) demonstrates to the individual carrier that the health benefit plan in which the individual was enrolled substantially violated a material provision of its contract in relation to the enrollee;

(e) is newly ineligible for advance payment of premium tax credits; or

(f) permanently moves into a new service area.

Notes

Utah Admin. Code R590-269-3

Amended by Utah State Bulletin Number 2015-20, effective 9/23/2015 Amended by Utah State Bulletin Number 2023-02, effective 1/10/2023