Md. Code Regs. 14.35.07.02

Current through Register Vol. 51, No. 24, December 2, 2024

Section 14.35.07.02 - Definitions

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

B. Terms Defined.

(1) "Applicant" means an individual who submits an application through the Individual Exchange for the individual and the individual's tax household, and is seeking eligibility for:

(a) Enrollment in a QHP through the Individual Exchange; or

(b) Enrollment in an insurance affordability program through the Individual Exchange.

(2) "COBRA" means the Consolidated Omnibus Budget Reconciliation Act of 1985 (Pub. I. 99-272).

(3) "CSR plan for up to 150 percent FPI" means a QHP available through the Individual Exchange with an actuarial value of 94 percent plus or minus the de minimis variation for a silver plan variation.

(4) "CSR plan for 151-200 percent FPI" means a QHP available through the Individual Exchange with an actuarial value of 87 percent plus or minus the de minimis variation for a silver plan variation.

(5) "CSR plan for 201-250 percent FPI" means a QHP available through the Individual Exchange with an actuarial value of 73 percent plus or minus the de minimis variation for a silver plan variation.

(6) "Dependent," for the purposes of Regulations .12-. 19 of this chapter, has the meaning stated in 26 CFR § 54.9801-2 with respect to eligibility for coverage under an individual QHP because of a relationship to a qualified individual or enrollee.

(7) "Employer group health insurance coverage " means health coverage offered by an employer to an employee and the employee's dependents, if eligible, under:

(a) Government health coverage, such as the Federal Employees Health Benefit program;

(b) Health coverage offered in the small or large group market by an employer within a state; or

(c) Grandfathered health coverage offered by an employer in a group market.

(8) "Federal poverty level (FPI) " means the most recently published federal poverty level guidelines, updated periodically in the Federal Register by the Secretary of HHS as set forth in 42 U.S.C § 9902(2), as of the first day of the open enrollment period for QHPs offered through the Individual Exchange for a calendar year.

(9) Household income" has the meaning stated in § 36B(d)(2) of the Internal Revenue Code.

(10) "Indian" means an individual who is a member of an Indian tribe, band, nation, or other organized group or community, including any Alaska Native village, or regional or village corporation as defined in or established under the Alaska Native Claims Settlement Act (85 Stat. 688), which is recognized as eligible for the special programs and services provided by the United States to Indians because of their status as Indians.

(11) "Institution" means:

(a) A medical institution under COMAR 10.09.24.02-.37; or

(b) A public institution under COMAR 10.09.24.02-.46.

(12) "Insurance affordability program" means a program that is one of the following:

(a) The Maryland State Medicaid Program;

(b) The Maryland Children's Health Insurance Program (CHIP), including the Maryland Children's Health Program (MCHP) Premium;

(c) A program that makes available to qualified individuals coverage in a QHP through the Individual Exchange with APTC credit under §1.36B(2)(c) of the Internal Revenue Code;

(d) A program that makes available coverage in a QHP through the Individual Exchange with CSR under § 1402 of the ACA; and

(e) The State-Based Young Adult Health Insurance Subsidies Program established under Insurance Article, § 31-122, Annotated Code of Maryland.

(13) "Non-applicant" means an individual who is not seeking eligibility for enrollment in a QHP or an insurance affordability program through the Individual Exchange.

(14) "Qualifying eligible employer-sponsored plan" means a health benefit plan that meets the requirements set forth in 26 CFR § 1.36B-2(c)(2)(i).

(15) "Rescission" means a cancellation or discontinuance of coverage that has retroactive effect.

(16) "Tax filer" means an individual or married couple who indicates that the tax filer expects:

(a) To file an income tax return for the benefit year, as set forth in 26 U.S.C. §§ 6011, 6012, and implementing regulations;

(b) If married, as set forth in 26 CFR § 1.7703-1, to file a joint tax return for the benefit year, except if the spouse is a victim of domestic violence or spousal abandonment;

(c) To not be claimed as a tax dependent by any other taxpayer for the benefit year; and

(d) To claim a personal exemption deduction set forth in § 151 of the Internal Revenue Code on the tax filer's return for one or more applicants, even if the tax filer is not an applicant.

Md. Code Regs. 14.35.07.02

Regulation .02 adopted effective 46:5 Md. R. 306, eff. 3/11/2019; amended effective 48:24 Md. R.1025, eff. 11/29/2021