Md. Code Regs. 10.25.01.04

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

Section 10.25.01.04 - Employer Eligibility

A. A small employer is eligible to receive a premium subsidy if, at the time of initial application for the premium subsidy, the employer:

(1) Meets the requirements under Insurance Article, §15-1203(b)(i), Annotated Code of Maryland;

(2) Has been in operation for at least 12 months and, if required to file quarterly wage reports, has filed quarterly wage reports with the Maryland Department of Labor, Licensing, and Regulation for, at a minimum, the three calendar quarters immediately preceding initial application for the premium subsidy;

(3) Has not offered a health benefit plan to its employees for at least 12 consecutive months immediately before initial application for the premium subsidy;

(4) Employed at least two but not more than nine eligible employees:

(a) At the time the employer's subsidy application is entered into the Commission registry; and

(b) On at least 50 percent of its working days during the preceding calendar quarter;

(5) Has an average wage of business that does not exceed the maximum average wage for new applications;

(6) Agrees to offer a health benefit plan to its eligible employees that contains a wellness benefit;

(7) Commits to establish a Section 125 payroll deduction plan within 60 days of enrollment in the Premium Subsidy Program;

(8) Completes and signs the subsidy application; and

(9) Complies with the other regulations of this chapter.

B. Affiliated companies are considered one employer for purposes of this chapter.

C. An enrolled employer is eligible to continue receiving a premium subsidy if, at the time of the renewal application, the employer:

(1) Has filed quarterly wage reports with the Maryland Department of Labor, Licensing, and Regulation for, at a minimum, the three calendar quarters immediately preceding the renewal application for the premium subsidy;

(2) Has at least two eligible employees and the number of eligible employees is not more than the maximum eligible firm size;

(3) Has an average wage of business that does not exceed the maximum average wage for participants;

(4) Continues to offer a health benefit plan to its eligible employees that contains a wellness benefit;

(5) Has an established Section 125 payroll deduction plan in place for at least 10 months;

(6) Completes and signs the subsidy application; and

(7) Complies with the other regulations of this chapter.

D. An enrolled employer whose coverage is terminated before the end of the policy year for any cause, including nonpayment of premium, is required to reapply and to meet all of the requirements for an initial application.

E. If the carrier terminates the coverage but then reinstates the employer's coverage with the same premium and policy expiration date, the employer shall be reinstated in the Premium Subsidy Program without reapplication.

F. Retroactive payments made by a small employer who is terminated and then reinstated by a carrier during a policy year are eligible for a premium subsidy.

Md. Code Regs. 10.25.01.04

Regulations .04 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)