1. (1) The provisions of Section R414-301-4 apply to applicants and members of the UPP program except that reportable changes for UPP applicants and members are defined in Subsection R414-320-3(2).

2. (2) An applicant or member must report certain changes to the eligibility agency within 10 calendar days of learning of the change. The eligibility agency shall notify the applicant at the time of application of the changes that the individual must report. Reportable changes include:

   1. (a) An member stops paying for coverage under an employer-sponsored health plan or COBRA coverage;
   2. (b) An member changes health insurance plans;
   3. (c) The amount of the premium that the member pays for an employer-sponsored health insurance plan or COBRA coverage changes;
   4. (d) An member begins to receive coverage under, or begins to have access to Medicare or the Veteran's Administration Health Care System;
   5. (e) An member leaves the household or dies;
   6. (f) An member or the household moves out of state;
   7. (g) Change of address of an member or the household; or
   8. (h) An member enters a public institution or an institution for mental diseases.
3. (3) An applicant or member has a right to request an agency conference or a fair hearing as described in Sections R414-301-6 and R414-301-7.
4. (4) An member must continue to pay premiums and remain enrolled in an employer-sponsored health plan or COBRA coverage to be eligible for benefits.
5. (5) An eligible child may choose to enroll in his parent's or guardian's employer-sponsored health insurance plan or COBRA coverage and receive UPP benefits, or may choose direct coverage through CHIP. A child under 19 years of age may enroll in an employer-sponsored health insurance plan offered by the child's employer or COBRA coverage and UPP, or may choose direct coverage through CHIP.

KEY: CHIP, Medicaid, PCN, UPP

Date of Last Change: July 1, 2024

Notice of Continuation: January 16, 2026

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