Utah Admin. Code R590-275-4 - Alternate Enrollment Process

(1) If an insurer will have no health insurance exchange option available for the upcoming plan year due to the insurer no longer offering an individual QHP in a particular service area in which it previously offered coverage on the health insurance exchange, the health insurance exchange shall direct enrollment for an enrollee to a QHP issued by a different insurer subject to Subsection (3) and the insurer's ability to absorb new enrollment.

(2) At renewal, if an enrollee does not have an individual QHP available from the same insurer through the health insurance exchange in which to enroll, the health insurance exchange shall direct enrollment for an enrollee to a QHP issued by a different insurer subject to Subsection (3) and the insurer's ability to absorb new enrollment.

(3)

(a) The enrollee's coverage will be matched to a QHP in the same service area:

(i) at the same metal level; or

(ii) if more than one QHP is available, the coverage will be matched to a QHP at the same metal level with the lowest premium.

(b) If no QHP is available at the same metal level in the same service area, the enrollee will be matched to a QHP in the same service area:

(i) that is one metal level lower than the enrollee's current QHP; or

(ii) if more than one QHP is available, coverage will be matched to a QHP at one metal level lower with the lowest premium.

(c) If no QHP is available at the same metal level or one metal level lower and in the same service area, the enrollee will be matched to a QHP that is:

(i) one metal level higher than the enrollee's current QHP; or

(ii) if more than one QHP is available at one metal level higher, coverage will be matched to a QHP at one metal level higher with the lowest premium.

(d) If no QHP is available at the same metal level, one metal level lower, or one metal level higher in the same service area, the enrollee will be matched to any QHP at any metal at the lowest premium in the same service area.

(4) The alternate enrollment provisions in Subsection (3) do not apply to an enrollee who terminates coverage, including termination of coverage in connection with voluntarily selecting a different QHP in accordance with 45 CFR 155.430.

Notes

Utah Admin. Code R590-275-4

Adopted by Utah State Bulletin Number 2017-22, effective 10/23/2017 Amended by Utah State Bulletin Number 2023-10, effective 5/9/2023