R414-320-12. Effective Date of Enrollment and Enrollment Period

  (1) Subject to Section R414-320-6, and the limitations in Section R414-306-4, the effective date of enrollment in the UPP program is the first day of the application month.

  (a) The effective date of enrollment for a newborn or adopted child is the date of birth or the date of adoption, if the request is made within 30 days of the date of birth or adoption.

  (b) If the request to add a newborn or adopted child is made after 30 days of the date of birth or the date of adoption, enrollment is effective on the first day of the month in which the date of request occurs.

  (2) An individual who is approved for the UPP program must enroll in the employer-sponsored health plan or COBRA within 30 days of receiving an approval notice from the eligibility agency.

  (3) If the applicant does not enroll in the employer-sponsored health insurance plan or COBRA within 30 days of the date that the eligibility agency sends the UPP approval notice, the eligibility agency shall deny the application.

  (4) The Department may not reimburse the enrollee for premiums before the effective date of enrollment and not before the month in which the enrollee pays a health insurance or COBRA premium. The enrollee must verify the premium payment.

  (5) The effective date of enrollment for an individual moving directly from Medicaid, PCN, or CHIP is the first day of the month after eligibility for Medicaid, PCN, or CHIP ends.

  (6) The effective date of reenrollment in UPP after the eligibility agency completes the periodic review, is the first day of the month after the review month, or the first day after the due process month. Subsection R414-320-11(5) defines the effective date of reenrollment when the enrollee completes the review process in the three calendar months after the case is closed for incomplete review.

  (7) An individual who becomes eligible for UPP is enrolled for a 12-month certification period that begins with the first month of eligibility.

  (8) The eligibility agency shall end eligibility before the end of a 12-month certification period for any of the following reasons:

  (a) The individual turns 65 years of age;

  (b) An enrolled child turns 19 years of age and was covered by the parent's or guardian's health insurance plan;

  (c) The individual becomes entitled to receive Medicare;

  (d) The individual becomes covered by VA Health Insurance, or fails to apply for VA health system coverage when potentially eligible;

  (e) The individual is determined eligible for Medicaid when the household requests a new eligibility determination for any household member;

  (f) The individual dies;

  (g) The individual moves out of state or cannot be located; or

  (h) The individual enters a public institution or an Institution for Mental Disease.

  (9) The eligibility agency shall end eligibility if an adult enrollee discontinues enrollment in employer-sponsored insurance or COBRA. The enrollee may switch to the PCN program if the enrollee meets PCN eligibility requirements.