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
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:
(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.
(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:
(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.