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 Federally Facilitated Marketplace will coincide with the open enrollment period for the Federally Facilitated Marketplace.

(b) Open enrollment period coverage begins on:

(i) January 1 for individuals who enroll on or before December 15;

(ii) the first day of the following month, for individuals who enroll between the first and the fifteenth of the month; and

(iii) the first day of the second following month for individuals who enroll between the sixteenth and the last day of the month.

(2)

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

(b) 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

(c) Coverage is effective the first day of the month following the date the carrier receives the request for special enrollment in the case of:

(i) marriage;

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

(iii) an individual or dependent's enrollment or non-enrollment is unintentional, inadvertent, or erroneous and is the 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 adequately demonstrates to the individual carrier that the health benefit plan in which he or she is previously enrolled substantially violated a material provision of its contract in relation to 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