Utah Admin. Code R590-269-4 - Open and Special Enrollment Periods

(1)

(a) The open enrollment period for an individual health benefit plan outside the health insurance exchange shall coincide with the open enrollment period for the health insurance exchange.

(b) Open enrollment period coverage begins on:

(i) January 1 for an individual who enrolls on or before December 15;

(ii) the first day of the following month, for an individual who enrolls between the first and the fifteenth of the month; and

(iii) the first day of the second following month for an individual who enrolls between the sixteenth and the last day of the month.

(2) An insurer shall offer an individual experiencing a qualifying life event a special enrollment period for at least 60 days.

(a) In the case of birth, adoption, or placement for adoption, the coverage is effective on the date of:

(i) birth;

(ii) adoption; or

(iii) placement for adoption.

(b) Coverage is effective on the first day of the month following the date the insurer receives the request for special enrollment when:

(i) an individual or dependent marries;

(ii) an individual or dependent loses minimum essential coverage;

(iii) an individual or dependent 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;

(iv) an individual demonstrates to the insurer that the health benefit plan in which the individual was enrolled substantially violated a material provision of its contract regarding the enrollee; or

(v) an individual permanently moves into a new service area.

Notes

Utah Admin. Code R590-269-4

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