OKDHS.org - OAC 317:45-11-23. Employee eligibility period

317:45-11-23. Employee eligibility period

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Revised 6-25-09

(a) The rules in this subsection apply to applicants eligible according to OAC 317:45-11-20(a) through (e).

(1) The employee's coverage period begins only after receipt of the premium payment.
- (A) If the application is received and approved before the 15th of the month, eligibility begins the first day of the second consecutive month. If the application is not received or approved before the 15th of the month, eligibility begins the first day of the 3rd consecutive month. (Examples: An application is received and approved on January 14^th and the premium is received before February 15^th, eligibility begins March 1^st; or an application is received and approved January 15^th and the premium is received on March 15^th, eligibility begins April 1^st.)
- (B) If premiums are paid early, eligibility still begins as scheduled.
(2) Employee eligibility is contingent upon the employer meeting the program guidelines.
(3) The employee's eligibility is determined by the TPA using the eligibility requirements listed in OAC 317:45-9-1 or OAC 317:45-11-20(a) through (e).
(4) If the employee is determined eligible for Insure Oklahoma/O-EPIC IP, he/she is approved for a period not greater than 12 months. The length of the eligibility period is based on the remaining number of months the employer has left in its eligibility period as defined in OAC 317:45-7-1, 317:45-7-2 and 317:45-7-8.

(b) The rules in this subsection apply to applicants eligible according to OAC 317:45-11-20(a) through (c) and OAC 317:45-11-20(f) through (h).

(1) The applicant's eligibility is determined by the TPA using the eligibility requirements listed in OAC 317:45-11-20(a) through (c) and OAC 317:45-11-20(f) through (h).
(2) If the applicant is determined eligible for Insure Oklahoma/O-EPIC IP, he/she is approved for a period not greater than 12 months.
(3) The applicant's eligibility period begins only after receipt of the premium payment.
- (A) If the application is received and approved before the 15th of the month, eligibility begins the first day of the second consecutive month. If the application is not received or approved before the 15th of the month, eligibility begins the first day of the 3rd consecutive month. (Examples: An application is approved on January 14^th and the premium is received before February 15^th, eligibility begins March 1^st; or an application is approved January 15^th and the premium is received on March 15^th, eligibility begins April 1^st.)
- (B) If premiums are paid early, eligibility still begins as scheduled.

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