Utah Code 31A-22-610.6. Special enrollment for individuals receiving premium assistance
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(1) As used in this section:
Terms Used In Utah Code 31A-22-610.6
- Beneficiary: A person who is entitled to receive the benefits or proceeds of a will, trust, insurance policy, retirement plan, annuity, or other contract. Source: OCC
- Dependent: A person dependent for support upon another.
- Eligible employee: includes :(55)(b)(i) an owner, sole proprietor, or partner who:(55)(b)(i)(A) works on a full-time basis;(55)(b)(i)(B) has a normal work week of 30 or more hours; and(55)(b)(i)(C) employs at least one common employee; and(55)(b)(ii) an independent contractor if the individual is included under a health benefit plan of a small employer. See Utah Code 31A-1-301
- Employee: means :
(57)(a) an individual employed by an employer; or(57)(b) an individual who meets the requirements of Subsection (55)(b). See Utah Code 31A-1-301- Health benefit plan: means a policy, contract, certificate, or agreement offered or issued by an insurer to provide, deliver, arrange for, pay for, or reimburse any of the costs of health care, including major medical expense coverage. See Utah Code 31A-1-301
- Health care: means any of the following intended for use in the diagnosis, treatment, mitigation, or prevention of a human ailment or impairment:
(83)(a) a professional service;(83)(b) a personal service;(83)(c) a facility;(83)(d) equipment;(83)(e) a device;(83)(f) supplies; or(83)(g) medicine. See Utah Code 31A-1-301- Individual: means a natural person. See Utah Code 31A-1-301
- Insurance: includes :
(96)(b)(i) a risk distributing arrangement providing for compensation or replacement for damages or loss through the provision of a service or a benefit in kind;(96)(b)(ii) a contract of guaranty or suretyship entered into by the guarantor or surety as a business and not as merely incidental to a business transaction; and(96)(b)(iii) a plan in which the risk does not rest upon the person who makes an arrangement, but with a class of persons who have agreed to share the risk. See Utah Code 31A-1-301- Month: means a calendar month, unless otherwise expressed. See Utah Code 68-3-12.5
- Premium: includes , however designated:
(156)(b)(i) an assessment;(156)(b)(ii) a membership fee;(156)(b)(iii) a required contribution; or(156)(b)(iv) monetary consideration. See Utah Code 31A-1-301(1)(a) “Premium assistance” means assistance under Title 26B, Chapter 3, Health Care – Administration and Assistance, in the payment of premium.(1)(b) “Qualified beneficiary” means an individual who is approved to receive premium assistance.(2) Subject to the other provisions in this section, an individual may enroll under this section at a time outside of an employer health benefit plan open enrollment period, regardless of previously waiving coverage, if the individual is:(2)(a) a qualified beneficiary who is eligible for coverage as an employee under the employer health benefit plan; or(2)(b) a dependent of the qualified beneficiary who is eligible for coverage under the employer health benefit plan.(3) To be eligible to enroll outside of an open enrollment period, an individual described in Subsection (2) shall enroll in the employer health benefit plan by no later than 30 days from the day on which the qualified beneficiary receives initial written notification, after July 1, 2008, that the qualified beneficiary is eligible to receive premium assistance.(4) An individual described in Subsection (2) may enroll under this section only in an employer health benefit plan that is available at the time of enrollment to similarly situated eligible employees or dependents of eligible employees.(5) Coverage under an employer health benefit plan for an individual described in Subsection (2) may begin as soon as the first day of the month immediately following enrollment of the individual in accordance with this section.(6) This section does not modify any requirement related to premiums that applies under an employer health benefit plan to a similarly situated eligible employee or dependent of an eligible employee under the employer health benefit plan.(7) An employer health benefit plan may require an individual described in Subsection (2) to satisfy a preexisting condition waiting period that:(7)(a) is allowed under the Health Insurance Portability and Accountability Act; and(7)(b) is not longer than 12 months. - Employee: means :