Library: Policy

317:45-9-7. Closure

Revised 6-25-11

(a) Employer and employee eligibility are tied together. If the employer is no longer eligible, then the associated employees enrolled under that employer are also ineligible. Employees are mailed a notice 10 days prior to closure of eligibility.

(b) The employee's certification period may be terminated when:

(1) termination of employment, either voluntary or involuntary, occurs;
(2) the employee moves out-of-state;
(3) the covered employee dies;
(4) the employer ends its contract with the qualified health plan;
(5) the employer's eligibility ends;
(6) an audit indicates a discrepancy that makes the employee or employer ineligible;
(7) the employer is terminated from the program;
(8) the employer fails to pay the premium;
(9) the qualified health plan or carrier no longer meets the requirements set forth in this Chapter;
(10) the employee becomes eligible for SoonerCare or Medicare;
(11) the employee or employer reports any change affecting eligibility;
(12) the employee is no longer listed as a covered person on the employer's health plan invoice;
(13) the employee requests closure; or
(14) the employee no longer meets the eligibility criteria set forth in this Chapter.