R414-310-3. Applicant and Enrollee Rights and Responsibilities

  (1) The provisions of Section R414-301-4 apply to applicants and enrollees of the PCN program except that reportable changes for PCN applicants and enrollees are defined in Subsection R414-310-3(2).

  (2) An applicant or enrollee must report certain changes to the eligibility agency within ten calendar days of the day the change becomes known. The eligibility agency shall notify the applicant at the time of application of the changes that the enrollee must report. Reportable changes include:

  (a) An enrollee in PCN begins to receive coverage or to have access to coverage under a group health plan or other health insurance coverage;

  (b) An enrollee in PCN begins to receive coverage under, or begins to have access to student health insurance, Medicare, or the Veteran's Administration Health Care System;

  (c) Changes in household income;

  (d) Changes in household composition;

  (e) Changes in tax filing status;

  (f) Changes in the number of dependents claimed as tax dependents;

  (g) An enrollee or the household moves out of state;

  (h) Change of address of an enrollee or the household; or

  (i) An enrollee enters a public institution or an institution for mental diseases.

  (3) An applicant or enrollee has a right to request an agency conference or a fair hearing as described in Sections R414-301-6 and R414-301-7.

  (4) An enrollee in PCN is responsible for paying any required copayments or coinsurance amounts to providers for medical services that the enrollee receives that are covered under PCN.