Utah Administrative Code
Topic - Health
Title R414 - Integrated Healthcare
Rule R414-310 - Medicaid Primary Care Network Demonstration Waiver
Section R414-310-2 - Definitions
Current through Bulletin 2024-06, March 15, 2024
The definitions in Rules R414-1 and R414-301 apply to this rule. In addition, the following definitions apply throughout this rule:
(1) "Avenue H" means Utah's Health Insurance Marketplace for Utah employers and their employees where the employees can find information about available employer-sponsored health insurance plans, select a plan and enroll online.
(2) "Best estimate" means the eligibility agency's determination of a household's income for the upcoming certification period based on past and current circumstances and anticipated future changes.
(3) "Children's Health Insurance Program" or (CHIP) means the program for medical benefits under Title 26, Chapter 40, Utah Children's Health Insurance Act.
(4) "Copayment and coinsurance" means a portion of the cost for a medical service for which the enrollee is responsible to pay for services received under the Primary Care Network.
(5) "Creditable Health Coverage" means any health insurance coverage as defined in 45 CFR 146.113.
(6) "Employer-sponsored health plan" means a health insurance plan offered by an employer either directly or through Avenue H.
(7) "Enrollee" means an individual who has applied for and has been found eligible for the Primary Care Network program.
(8) "Open enrollment" means a period during which the eligibility agency accepts applications for the Primary Care Network program.
(9) "Primary Care Network" or (PCN) means the program for benefits under the Medicaid Primary Care Network Demonstration Waiver.
(10) "Review month" means the last month of the review period for an enrollee during which the eligibility agency shall redetermine eligibility for a new review period if the enrollee completes the review process timely.
(11) "Student health insurance plan" means a health insurance plan that is offered to students directly through a university or other educational facility.
(12) "Utah's Premium Partnership for Health Insurance" or (UPP) means the program described in Rule R414-320.
