Section R382-10-4 - Applicant and Enrollee Rights and Responsibilities(1) A parent or an adult who assumes responsibility for the care or supervision of a child may apply or reapply for CHIP benefits on behalf of a child. A child who is independent may apply on the child's own behalf.(2) If a person needs assistance to apply, the person may request assistance from a friend, family member, the eligibility agency, or outreach staff.(3) The applicant must provide verification requested by the eligibility agency to establish the eligibility of the child, including information about the parents.(4) Anyone may look at the eligibility policy manuals located online or at any eligibility agency office that is not an outreach or telephone-only location.(5) If the eligibility agency determines that the child received CHIP coverage during a period when the child was not eligible for CHIP, the parent, child, or legal guardian who arranges for medical services on behalf of the child must repay the department for the cost of services.(6) The parent or child, or other responsible person acting on behalf of a child, must report certain changes to the eligibility agency.(a) The following changes are reportable within ten calendar days of the day of the change:(i) the member begins to receive coverage or to have access to coverage under a group health plan or other health insurance coverage;(ii) the member leaves the household or dies;(iii) the member or the household moves out of state;(iv) the member or the household changes address; and(v) the member enters a public institution or an institution for mental disease.(b) Certain changes are reportable as part of the review process if these changes occurred anytime during the certification period and before the 10-day notice due date in the review month. The member must report a change in the following as part of the review process for any household member: (ii) gross income of $25 or more;(iv) pregnancy or termination of a pregnancy;(v) number of dependents claimed as tax dependents;(vi) earnings of a child;(vii) marital status; and(viii) student status of a child under 24 years of age.(7) An applicant and a member may review the information that the eligibility agency uses to determine eligibility.(8) An applicant and a member have the right to be notified about actions that the agency takes to determine the applicant's or member's eligibility or continued eligibility, the right to be notified about the reason the action was taken, and the right to request an agency conference or agency action as defined in Section R414-301-6 and Section R414-301-7.(9) A CHIP member must pay copayments or coinsurance amounts to providers for medical services that the member receives under CHIP.Utah Admin. Code R382-10-4
Amended by Utah State Bulletin Number 2014-22, effective 11/1/2014Amended by Utah State Bulletin Number 2015-8, effective 4/1/2015Amended by Utah State Bulletin Number 2015-23, effective 11/16/2015Amended by Utah State Bulletin Number 2024-14, effective 7/1/2024