Ala. Admin. Code r. 482-1-115-.05

Current through Register Vol. 43, No. 1, October 31, 2024

Section 482-1-115-.05 - Eligibility

(1) Any individual person, who is and continues to be a resident and who has prior continuous coverage shall be eligible for Plan coverage if evidence is provided of all of the following:

(a) That prior coverage was not terminated because of fraud or nonpayment of premium by the individual.

(b) That if the person was offered the option of continuation coverage under federal or state law, the person has both elected and exhausted the continuation coverage.

(c) That the person's most recent prior continuous coverage was under a "group health plan", a "government plan" or a "church plan," (or health insurance offered in connection with any of these plans) as these plans are defined by federal law or regulation.

(1) Each resident dependent of an individual person who is eligible for Plan coverage shall be eligible for Plan coverage.

(2) An individual person shall not be eligible for coverage under the Plan in any of the following instances:

(a) The person is eligible for group coverage under other health insurance.

(b) The person is determined to be eligible for health insurance under Medicaid.

(c) The person is determined to be eligible for health insurance under Medicare.

(d) The person is enrolled in any other health insurance plan.

(4) Coverage shall cease upon any of the following events:

(a) On the date a person requests coverage to end.

(b) Upon the death of the covered person.

(c) On the date state law requires cancellation of the policy.

(d) Nonpayment of the required premiums.

(e) On the date a person ceases to be a resident.

(f) On the last day of the month in which a covered person is no longer eligible for the Plan.

Author: Elizabeth Bookwalter, Associate Counsel

Ala. Admin. Code r. 482-1-115-.05

New Rule: July 23, 1997; effective August 30, 1997. Revised: November 13, 2002; effective December 29, 2002. Filed with LRS December 19, 2002. Rule is not subject to the Alabama Administrative Procedure Act.

Statutory Authority:Code of Ala. 1975, §§ 27-2-17, 27-52-1, etseq.