1. (a) When the medicaid recipient loses medicaid eligibility, premium payments shall be discontinued as of the month of medicaid ineligibility.
2. (b) Coverage of any medicaid benefits provided outside the employer group health plan, including any wrap around services, shall end on the date the medicaid recipient loses medicaid eligibility.
3. (c) If the department determines that the employer group health plan is no longer cost effective, HIPP premium payment shall be discontinued the month following the date of the termination letter or for redeterminations on the renewal date of the employer group health plan.
4. (d) If the policyholder fails to provide the information necessary to establish ongoing HIPP eligibility within 30 calendar days prior to employer group health plan renewal date, the policyholder shall be terminated from the HIPP program on the date when the insurance plan annually ends.
5. (e) If the policyholder does not have the employer group health plan renewal information 30 days prior, then the medicaid recipient or policyholder shall notify the department and submit the information within 2 business days of receiving the renewal information.
6. (f) If the policyholder disenrolls from their cost effective employer group health plan, the premium payments shall be discontinued as of the date of disenrollment.
7. (g) If the employer group health plan is no longer available or the policy has lapsed, premium payments shall be discontinued as of the effective date of the termination of the coverage.
8. (h) If the policyholder does not inform the department of the loss of the employer group health plan for any reason or any change in the employer group health plan and received premiums beyond the termination or change of the employer group health plan, the policyholder shall be required to refund to the department any premium and cost sharing over payments.

Source. #10632, eff 7-1-14; ss by #14075, eff 9-20-24, EXPIRES: 9-20-34