R382-10-10. Creditable Health Coverage

  (1) To be eligible for enrollment in the program, a child must meet the requirements of Sections 2110(b) of the Compilation of Social Security Laws.

  (2) A child who is covered under a group health plan or other health insurance that provides coverage in Utah, including coverage under a parent's or legal guardian's employer, as defined in 29 CFR 2590.701-4, July 1, 2013 ed., is not eligible for CHIP assistance.

  (3) A child who has access to health insurance coverage, where the cost to enroll the child in the least expensive plan offered by the employer is less than 5% of the countable MAGI-based income for the individual, is not eligible for CHIP. The child is considered to have access to coverage even when the employer only offers coverage during an open enrollment period, and the child has had at least one chance to enroll.

  (4) An eligible child who has access to an employer-sponsored health plan, where the cost to enroll the child in the least expensive plan offered by the employer equals or exceeds 5% of the countable MAGI-based income for the individual may choose to enroll in either CHIP or UPP.

  (a) To enroll in UPP, the child must meet UPP eligibility requirements.

  (b) If the UPP eligible child enrolls in the employer-sponsored health plan or COBRA coverage, but the plan does not include dental benefits, the child may receive dental-only benefits through CHIP.

  (c) If the employer-sponsored health plan or COBRA coverage includes dental, the applicant may choose to enroll the child in the dental plan and receive an additional reimbursement from UPP, or receive dental-only benefits through CHIP.

  (d) A child enrolled in CHIP who gains access to or enrolls in an employer-sponsored health plan may switch to the UPP program if the child meets UPP eligibility requirements.

  (5) The cost of coverage includes the following:

  (a) the premium;

  (b) a deductible, if the employer-sponsored plan has a deductible; and

  (c) the cost to enroll the employee, if the employee must be enrolled to enroll the child.

  (6) Subject to the provisions published in 42 CFR 457.805(b), October 1, 2015 ed., which the Department adopts and incorporates by reference, the eligibility agency shall deny eligibility and impose a 90-day waiting period for enrollment under CHIP if the applicant or a custodial parent voluntarily terminates health insurance that provides coverage in Utah within the 90 days before the application date. In addition, the agency may not apply a 90-day waiting period in the following situations:

  (a) a non-custodial parent voluntarily terminates coverage;

  (b) the child is voluntarily terminated from insurance that does not provide coverage in Utah;

  (c) the child is voluntarily terminated from a limited health insurance plan;

  (d) a child is terminated from a custodial parent's insurance because ORS reverses the forced enrollment requirement due to the insurance being unaffordable;

  (e) voluntary termination of COBRA;

  (f) voluntary termination of Utah Comprehensive Health Insurance Pool coverage; or

  (g) voluntary termination of UPP reimbursed, employer-sponsored coverage.

  (7) If the 90-day ineligibility period for CHIP ends in the month of application, or by the end of the month that follows, the eligibility agency shall determine the applicant's eligibility.

  (a) If eligible, enrollment in CHIP begins the day after the 90-day ineligibility period ends.

  (b) If the 90-day ineligibility period does not end by the end of the month that follows the application month, the eligibility agency shall deny CHIP eligibility.

  (8) The Department shall comply with the provisions of enrollment after the waiting period in accordance with 42 CFR 457.340, October 1, 2015 ed., which the Department adopts and incorporates by reference.

  (9) A child with creditable health coverage operated or financed by Indian Health Services is not excluded from enrolling in CHIP.

  (10) A child who has access to state-employee health insurance as defined in 42 CFR 457.310 is not eligible for CHIP assistance.