Utah Administrative Code
Topic - Health
Title R414 - Integrated Healthcare
Rule R414-312 - Adult Expansion Medicaid
Section R414-312-5 - Enrollment in Employer-Sponsored Insurance Requirements

Universal Citation: UT Admin Code R 414-312-5

Current through Bulletin 2024-06, March 15, 2024

The Department may require individuals with access to a qualified health plan through their employer to enroll. The employer-sponsored insurance (ESI) must meet the qualified health plan requirements as described in Section R414-312-2.

(1) The following individuals are not required to participate in ESI:

(a) a member of a federally recognized tribe;

(b) an individual who is under 26 years of age and on a parent's health insurance plan; and

(c) an individual who is already enrolled in a non-qualified health plan.

(2) A member must enroll in ESI within 30 days of receiving the approval notice, and provide proof of enrollment and the premium start date within the following 15 days or be sanctioned from receiving adult expansion coverage.

(a) The Department shall sanction an individual who does not participate in ESI from receiving adult expansion coverage for a period of 12 consecutive months.

(b) An individual may qualify for a different medical assistance program during the sanction period. If so, the sanction does not apply to that assistance program. The 12-month sanction period, however, continues to apply to the Adult Expansion program if the individual loses other eligibility and could only qualify under the Adult Expansion program.

(3) Individuals whose assistance ends due to an ESI sanction may reapply at any time.

(4) The Department may only lift a sanction and approve Adult Expansion coverage if the individual verifies one of the following:

(a) enrollment in ESI coverage;

(b) the employer no longer offers ESI;

(c) the employer no longer offers a qualified health insurance plan; or

(d) the member no longer has access to health insurance due to termination or loss of job.

(5) If the Department lifts a sanction, a beneficiary must report the exemption and verify it timely for the effective date of coverage to be the first day of the month of report or month of reapplication.

(6) If a beneficiary does not report timely or verify an exemption, the effective date of coverage is the first day of the month in which the beneficiary verifies the exemption.

(7) The Department may reimburse an individual for ESI premiums. If the employer deducts the health insurance premium in a month before the effective date, the Department may send the first ESI reimbursement payment in the month the premium is paid, but not before the application date. The Department shall send subsequent ESI premium reimbursements on a monthly basis.

Disclaimer: These regulations may not be the most recent version. Utah may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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