(a) Employee applications are submitted to the TPA.

(b) The eligibility determination is processed within 30 days from the date the application is received by the TPA.  The employee is notified in writing of the eligibility decision.

(c) All eligible employees described in this Section are enrolled in their Employer's QHP.  Eligible employees must:

• (1) have a countable household income at or below 200% of the Federal Poverty Level.  The standard deduction for work related expenses such as income tax payments, Social Security taxes, and transportation to and from work, is $240 per each full-time or part-time employed member;
• (2) be a US citizen or alien as described in OAC 317:35-5-25;
• (3) be Oklahoma residents;
• (4) provide social security number for all household members;
• (5) not be receiving benefits from SoonerCare/Medicare;
• (6) be employed with a qualified employer at a business location in Oklahoma;
• (7) be age 19 through age 64 or an emancipated minor;
• (8) be eligible for enrollment in the employer's QHP;
• (9) not have full-time employment with any employer who does not meet the eligible employer guidelines listed in OAC 317:45-7-1(a)(1)-(2); and
• (10) select one of the QHPs the employer is offering.

(d) An employee's dependents are eligible when:

• (1) the employer's health plan includes coverage for dependents;
• (2) the employee is eligible;
• (3) if employed, the spouse may not have full-time employment with any employer who does not meet the eligible employer guidelines listed in OAC 317:45-7-1(a)(1)-(2); and
• (4) the dependents are enrolled in the same health plan as the employee.

(e) If an employee or their dependents are eligible for multiple QHPs, each may receive a subsidy under only one health plan.