Utah Administrative Code
Topic - Health
Title R414 - Integrated Healthcare
Rule R414-312 - Adult Expansion Medicaid
Section R414-312-2 - Definitions
Universal Citation: UT Admin Code R 414-312-2
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.
(1) "Certification period" means the 12-month time frame in which an individual is eligible for coverage based on an approved application or review.
(2) "Employer-sponsored health plan" means a health insurance plan offered by an employer
(3) "Medically frail" means an individual as described in 42 CFR 440.315(f).
(4) "Qualified health plan" means a health plan that meets the following:
(a) the plan
covers physician visits, hospital inpatient services, pharmacy, well-child
exams, and child immunizations;
(b)
the network deductible is $4,000 or less per person;
(c) the plan pays at least 70% of an
in-network inpatient stay after the deductible;
(d) the plan does not cover abortion
services, or the plan only covers abortion services when the life of the mother
would be endangered if the fetus were carried to term, or in the case of incest
or rape;
(e) the employer pays at
least 50% of the premium for the primary-insured individual; and
(f) the lifetime maximum benefits must be at
least $1,000,000.
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