Eligibility
WHO IS ELIGIBLE?

Any person who has resided in Utah for at least one year, the twelve consecutive months immediately preceding the date of application for HIP; or who is a dependent child 25 years of age or less of such person, is eligible for HIP coverage if the person:

-Pays the established premium; and

-Meets the required health conditions and underwriting criteria established by the State of Utah; and

-Does not fall into the ineligible categories listed later in this outline.

Any person who is a Utah resident and is eligible as defined above does not need to meet
the twelve consecutive month requirement if the person:

Has terminated similar coverage from a State Health Risk Pool in another state and has moved to Utah, and applies for HIP within 63 days of termination; or

Is HIPAA eligible which (means the Federal "Health Insurance Portability and Accountability Act" of 1996) annd has at least 18 monlhs of prior coverage the most recent prior coverage which was under a group heath plan, government plan, or church plan; and has elected and exhausted COBRA or State Continuation Plan, where available and applies within 31 days of termination.

A person is not eligible for HIP coverage if any of the following is true:

The person it eligible for benefits under Medicaid or Medicare as provided in Utah Code 31A.29.112, unless the person has a spend-down, as provided in the Medicaid Administrative Rule, that exceeds the premium for a Hip Policy;

HIP coverage has been terminated within the last 12 months unless the person demonstrates that continuous other coverage has been involuntarily terminated for any reason other than non-payment of premium;

The person has exhausted the maximum lifetime benefits of the HIP Policy

The person is an inmate of a public institution (unless HIPAA eligible);

The person is eligible for other public programs for which medical care is provided;

The person is eligible for group health insurance through an employer plan; or

On the effective dale of HIP coverage, the person has coverage substantially equivalent to HIP coverage either as an insured or a covered dependent or who would be eligible if the person elected to obtain such coverage.