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plan. RIte Share participants receive coverage comparable in scope, amount, and duration to coverage provided in a Medicaid managed care plan. 1. Cost-effectiveness test – To be cost-effective, the policy holder’s monthly ESI premium share, deductibles, co-insurance, plus any Medicaid covered services not covered by the ESI plan (such as services covered under the managed care contracts, but not under the ESI plan), must be less than the average capitation payment for a member enrolled in a Medicaid managed care plan. These average costs must be actuarially determined at such intervals as deemed appropriate by EOHHS. 2. The analysis of cost effectiveness is dependent on the Medicaid eligibility status of each member of the household. Cost effectiveness determinations will be based on one of the following scenarios as applicable: a. Household in which all individuals are Medicaid-eligible; b. Household in which only child(ren) and/or pregnant women in the family are Medicaid-eligible; c. Household in which childless adult is Medicaid-eligible; or B. The figures used as the basis for assessing cost-effectiveness shall be made available, upon request, by EOHHS. 3.12 Scope and Consequence of Approving an ESI Plan

RIte Share-approved ESI plans need to be reevaluated on an annual basis, in alignment with annual renewals of employer insurance, to ensure that the ESI remains cost-effective. From the date an ESI plan is approved until the date it is reevaluated, any Medicaid members who work for that employer, and their Medicaid-eligible dependents, must enroll in the ESI through RIte Share. 3.13 Member Enrollment Process A. Medicaid members who are required to participate in RIte Share must enroll in the ESI plan as directed by EOHHS. Enrollment into RIte Share may occur upon initial determination or at the time of Medicaid annual renewal, or as deemed appropriate by EOHHS. Enrollment in RIte Share is considered to be a “qualifying event” and may occur at any time, including outside of the employer’s open enrollment period. Additionally, according to section 701(f)(3) of the Employee Retirement Income Security Act of 1974 (“ERISA”), 29 U.S.C. § 1181(f)(3), a group health plan must permit an employee (or dependent) who is: 1 eligible for but not enrolled in the ESI, and