Md. Code Regs. 10.25.01.02

Current through Register Vol. 51, No. 22, November 1, 2024

Section 10.25.01.02 - Definitions

A. In this chapter, the following terms have the meanings indicated.

B. Terms Defined.

(1) "Affiliated companies" means companies that are eligible to file a consolidated federal income tax return.

(2) "Average wage of business" means the average of the annual wage of all eligible employees; for each eligible owner, the wage used to calculate the average for the business shall be the lesser of:

(a) The eligible owner's countable wage; or

(b) The eligible owner's adjusted gross income.

(3) "Carrier" has the meaning stated in Insurance Article, §15-1201(c), Annotated Code of Maryland.

(4) "COMAR" means the Code of Maryland Regulations.

(5) "Commission" means the Maryland Health Care Commission.

(6) "Commission registry" means a web-based utility by which employers and employees are enrolled in the Premium Subsidy Program.

(7) "Commission's official website" means http://mhcc.maryland.gov/.

(8) "Designated financial institution" means one or more financial institutions with whom the participating carrier has made arrangements for administration of HSAs in conjunction with the participating carrier's HSA compatible health benefit plan.

(9) "Eligible employee" means an individual who:

(a) Works on a full-time basis and has a normal workweek of at least 30 hours; and

(b) Is either:

(i) An employee;

(ii) A partner of a partnership;

(iii) An eligible owner; or

(iv) An independent contractor who is included as an employee under a health benefit plan.

(10) Eligible Owner.

(a) "Eligible owner" means:

(i) A person with a 20 percent or greater financial interest in a small employer who works at least 30 hours per week for that small employer; or

(ii) An Executive Director of a nonprofit corporation that has been determined by the Internal Revenue Service to be exempt from taxation under § 501(c)(3), (4), or (6) of the Internal Revenue Code who works at least 30 hours per week for that small employer.

(b) "Eligible owner" includes an eligible owner's spouse who works at least 30 hours per week for the small employer.

(11) "Eligible owner's adjusted gross income" means an amount equal to the adjusted gross income reported on the eligible owner's individual federal tax return or 50 percent of the adjusted gross income reported on the eligible owner's joint federal tax return for the most recent year.

(12) "Eligible owner's countable wage" means an amount published by the Commission used to calculate the average wage of a small employer.

(13) "Employee premium" means the amount of the premium that is paid by the employee for that employee's selected type of coverage.

(14) "Employee premium subsidy" means, for a given employee's selected type of coverage, the amount of the premium subsidy that shall be passed through to the enrolled employee by the employer in the form of reduced payroll deductions for the health benefit plan.

(15) "Employee's eligible HSA contribution" means the lesser of:

(a) An amount published by the Commission; or

(b) An employee's contribution to an HSA, made through regular payroll deductions deposited by the employer on behalf of the employee in the employee's HSA established at the carrier's designated financial institution.

(16) Employee Wage.

(a) "Employee wage" means, for a given eligible employee, the employee's estimated annual earnings at the time of initial or renewal application for the Premium Subsidy Program, including any salary, wages, commissions, bonuses, profit sharing, and reportable tips.

(b) "Employee wage" includes, for purposes of this program, income received from an employee's ownership interest in the business.

(17) "Employer's eligible HSA contribution" means an annual contribution to an employee's HSA:

(a) Established at the carrier's designated financial institution;

(b) Made by an employer according to a commitment made at enrollment or renewal;

(c) Equal for all employees choosing a given HSA-compatible health benefit plan; and

(d) Contributed either in a single payment at the beginning of the policy year or in equal installments throughout the policy year.

(18) "Enrolled employee" means an eligible employee approved by the Commission to receive the premium subsidy.

(19) "Enrolled employer" means a small employer approved by the Commission to receive the premium subsidy.

(20) "Family" has the meaning stated in COMAR 31.11.06.02B(19).

(21) Family Adjusted Gross Income.

(a) "Family adjusted gross income" means, for an unmarried employee and for a married employee filing jointly, the adjusted gross income reported on the employee's most recent federal tax return.

(b) "Family adjusted gross income", for a married employee filing separately, means the sum of the adjusted gross income reported on the employee's most recent federal tax return and the adjusted gross income reported on the most recent federal tax return of the employee's spouse.

(22) "Health benefit plan" has the meaning stated in Insurance Article, §15-1201(f), Annotated Code of Maryland.

(23) "Health insurance" has the meaning stated in Insurance Article, §1-101(p), Annotated Code of Maryland.

(24) "Health savings account (HSA)" means a health savings account as defined in the Medicare Prescription Drug, Improvement and Modernization Act of 2003, Title 12, § 1201(a), as codified at Part VII, Subchapter B, Chapter 1, §223(d) of the Internal Revenue Code.

(25) "Individual coverage" means a health benefit plan that insures an individual employee only.

(26) "Initial application" means a subsidy applicant's first application to receive the premium subsidy.

(27) "Licensed insurance producer" has the meaning stated in Insurance Article, §1-101(w), Annotated Code of Maryland.

(28) "Maximum average wage for new applications" means an amount published by the Commission that represents the maximum average annual wage at which an employer not currently participating in the Premium Subsidy Program is eligible to apply for participation.

(29) "Maximum average wage for participants" means an amount published by the Commission that represents the maximum average annual wage, calculated at time of renewal, at which an enrolled employer may continue to participate in the Premium Subsidy Program.

(30) "Maximum eligible firm size" means a number published by the Commission that represents the largest number of eligible employees a small business may have at the time of policy renewal and still be eligible for participation in the Premium Subsidy Program.

(31) "Maximum income for other than individual coverage" means an amount published by the Commission that represents the maximum family adjusted gross income at which an eligible employee may receive a premium subsidy for other than individual coverage.

(32) "Maximum subsidy table" means a table published by the Commission that describes, for each type of coverage and average wage of business, the maximum premium subsidy that may be provided for each employee electing that type of coverage.

(32-1) "Minimum countable wage" means an amount published by the Commission that represents the minimum annual wage for an eligible employee that can be used to calculate the average wage of a small employer.

(33) "Other than individual coverage" means the following types of coverage:

(a) Individual plus children;

(b) Individual plus spouse; or

(c) Individual plus children and spouse.

(34) "Participating carrier" means a carrier who:

(a) Participates in the Maryland small group market as defined under COMAR 31.11.06;

(b) Agrees to offer a qualifying health plan; and

(c) Enters into a written participation agreement with the Commission.

(35) "Policy" has the meaning stated in Insurance Article, §1-101(ee), Annotated Code of Maryland.

(36) "Policy year" means a 365-day period that begins on the policy's effective date or a period of 1 full calendar-year, under a health benefit plan providing coverage to employers and their employees, as defined in the policy.

(37) "Premium" has the meaning stated in Insurance Article, §1-101(ff), Annotated Code of Maryland, applied to a given employee's selected type of coverage.

(38) "Premium subsidy" means the amount paid to the participating carrier by the State in order to reduce the premium paid by the enrolled employer for a given eligible employee's selected type of coverage.

(39) "Premium Subsidy Program" means the Small Employer Health Benefit Plan Premium Subsidy Program, as defined in Insurance Article, § 15-12 A-02, Annotated Code of Maryland.

(40) "Prominent carrier" means a carrier that insures at least 10 percent of the total lives insured in the small group market.

(41) "Qualifying health plan" means a Comprehensive Standard Health Benefit Plan, as defined under COMAR 31.11.06, together with riders, that includes a wellness benefit defined in Insurance Article, §15-1201(s), Annotated Code of Maryland.

(42) "Quarterly wage reports" means the reporting of wages on quarterly employment reports as described in COMAR 09.32.01.14B.

(43) "Renewal application" means an application designated by the Commission for applying for renewal of the premium subsidy.

(44) "Section 125 Payroll Deduction Plan" means a payroll deduction plan pursuant to §125 of the Internal Revenue Code.

(45) "Size factor" means a factor published by the Commission, based on the number of eligible employees of a small employer at the time of policy renewal, and used to calculate the premium subsidy.

(46) "Small employer" has the meaning stated in Insurance Article, §15-1201, Annotated Code of Maryland.

(47) "Subsidy administrator" means one or more entities:

(a) Designated by the participating carrier to administer enrollment, registration, billing, accounting, or reconciliation on behalf of the participating carrier; and

(b) That is either a component of the carrier organization, or a separate entity under contract with the participating carrier that is bonded and subject to audit by the participating carrier and the Commission.

(48) "Subsidy applicant" means either an employer or employee applying to receive the premium subsidy.

(49) "Subsidy application" means an application designated by the Commission to be completed, signed, and submitted in order for the Commission to determine eligibility for the Premium Subsidy Program.

(50) "Subsidy program cap" means a dollar amount published by the Commission that represents the Commission's estimate of the total annualized subsidy payment that is sustainable.

(51) "Total premium" means the sum of all premiums for coverage under the employer's health benefit plan.

(52) "Total premium subsidy" means the sum of all premium subsidies for coverage under the employer's health benefit plan.

(53) "Type of coverage" means the choice of coverage for each eligible employee's health benefit plan, specifically:

(a) Individual only;

(b) Individual plus children;

(c) Individual plus spouse; or

(d) Individual plus children and spouse.

(54) "Wellness benefit" has the meaning stated in Insurance Article, §15-201, Annotated Code of Maryland.

(55) "Written participation agreement" means a contract between a participating carrier and the Commission that defines:

(a) The terms and conditions of the participating carrier's involvement in the Premium Subsidy Program; and

(b) The roles and responsibilities of the subsidy administrator in administering the Premium Subsidy Program.

Md. Code Regs. 10.25.01.02

Regulations .02 adopted as an emergency provision effective June 12, 2008 (35:14 Md. R. 1243); adopted permanently effective August 25, 2008 (35:17 Md. R. 1486)
Regulation .02B amended as an emergency provision effective July 16, 2009 (36:17 Md. R. 1310); amended permanently effective October 19, 2009 (36:21 Md. R. 1591)