1. (1) "Certification period" means the 12-month time frame in which an individual is eligible for coverage based on an approved application or review.
2. (2) "Employer-sponsored health plan" means a health insurance plan offered by an employer.
3. (3) "Medically frail" means an individual as described in 42 CFR 440.315(f).

4. (4) "Qualified health plan" means a health plan that meets the following:

   1. (a) the plan covers physician visits, hospital inpatient services, pharmacy, well-child exams, and child immunizations;
   2. (b) the network deductible is $4,000 or less per person;
   3. (c) the plan pays at least 70% of an in-network inpatient stay after the deductible;
   4. (d) the plan does not cover abortion services, or the plan only covers abortion services when the life of the mother would be endangered if the fetus were carried to term, or in the case of incest or rape;
   5. (e) the employer pays at least 50% of the premium for the primary-insured individual; and
   6. (f) the lifetime maximum benefits must be at least $1,000,000.

The definitions in Rules R414-1 and R414-301 apply to this rule. In addition, the following definitions apply.

KEY: Medicaid, adult expansion, eligibility

Date of Last Change: July 2, 2025

Notice of Continuation: August 12, 2024

Authorizing, and Implemented or Interpreted Law: 26B-3-108; 26B-1-213