1. (a)

   1. (1) Health plans usually limit an individual's enrollment period.
   2. (2) If an individual who is already enrolled in a health plan becomes Medicaid eligible, the Division of Medical Services may cover premium payments as of the effective date of Medicaid eligibility.

2. (b) Effective date of benefit.

   1. (1) If a client is not eligible for coverage under a health plan for a specified waiting period, the division may cover the premium as of the effective date of eligibility for the health plan.
   2. (2) Until the client is eligible to enroll or entitled to receive services under the health plan, all Medicaid-covered services are covered and paid under the usual Medicaid policies and procedures.

3. (c) Delayed enrollment.

   1. (1) If the availability for enrollment in the health plan and eligibility for Medicaid do not coincide, the client/applicant shall apply for HIPP eligibility.
   2. (2) The client/applicant will be enrolled in the health plan when eligible if still cost effective.

4. (d) Annual renewal.

   1. (1) Cost effectiveness shall be reviewed at least annually.
   2. (2) At least six (6) months of claims or EOBs will be reviewed during the renewal period.
   3. (3) The annual renewal may coincide with the employer’s open enrollment period for employer sponsored plans.

Codification Notes: "EOB" means explanation of benefits.