Voluntary Termination of Health Insurance Coverage - 90 Day Waiting Period
With some exceptions, a child is not eligible for CHIP enrollment for a period of 90 days if he or she, or the custodial parent or guardian has:
Voluntarily terminated coverage of any health insurance plan for the child within 90 days before applying for CHIP; OR
Voluntarily changed a child's comprehensive health insurance plan to a limited health plan within 90 days before applying for CHIP.
The period of ineligibility is 90 days from date the insurance coverage ended. Individuals may be eligible beginning the 91st day after the date the prior insurance coverage ended. If an application was received during the 90 days sanction period, the individual is not required to reapply when the sanction period ends.
Exceptions to 90-day sanction period include:
Voluntary termination of COBRA coverage.
Voluntary termination of coverage by a non-custodial parent.
Voluntary termination of UPP reimbursed, employer-sponsored coverage.
Voluntary termination of insurance that does not provide coverage in Utah.
Voluntary termination of a limited health insurance plan. (See section 220-3.)
Voluntary termination of an FFM plan.
ORS forces enrollment under NMSN (National Medical Support Notice). Then, because the cost of insurance exceeds 5% of the gross monthly income after any applicable 5% disregard is applied, ORS reverses the forced enrollment and the child is terminated from the TPL of the custodial parent.
Voluntary termination of insurance when the premium paid that includes coverage for the child exceeds 5% of the monthly individual countable income after any applicable 5% disregard is applied.
If the best estimate using the current income shows the cost is less than 5% of the individual countable income after any applicable 5% disregard is applied and the customer disagrees, the customer may submit verifications of the income at the time the insurance was terminated to verify that the cost did exceed 5% at that time.
Voluntary termination of insurance when the cost of the premium and deductible for coverage that includes the child exceeds 9.5% of the monthly individual countable income after any applicable 5% disregard is applied.
If the best estimate using the current income shows the cost is less than 9.5% of the individual countable income after any applicable 5% disregard is applied and the customer disagrees, the customer may submit verifications of the income at the time the insurance was terminated to verify that the cost did exceed 9.5% at that time.
The child has special health care needs. The definition of a child with special health care needs is as follows. Customer statement will be accepted. If there are questions, please contact a Department of Health and Human Services policy specialist.
A child under age 21 who is at risk for chronic physical, developmental, behavioral, or emotional conditions and who requires health and related services of a type or amount beyond that required by children generally. A child with special health care needs includes but is not limited to a child who:
is blind or disabled
is eligible for SSI
is in Foster Care or other type of out-of-home placement
is receiving Foster Care assistance or adoption assistance
The child lost coverage due to the death or divorce of a parent.
A child’s parent is determined eligible for an APTC for enrollment in a Qualified Health Plan through the FFM because the employer sponsored insurance in which the family was enrolled is determined unaffordable by the FFM.
Involuntary Termination of Coverage
An applicant who is involuntarily terminated from a group health plan may be eligible for CHIP enrollment at application. The 90 day sanction period does not apply when:
The employer terminates the group health plan for all of its employees;
The employer stopped offering coverage of dependents;
A change in employment, including involuntary separation, resulted in the loss of access to employer-sponsored insurance;
A child whose FFM plan is voluntarily terminated.