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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.

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