Md. Code Regs. 14.35.07.04

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

Section 14.35.07.04 - Notice Requirements

A. The Individual Exchange shall provide timely written notice to an applicant of any eligibility determination made under this chapter as set forth in 45 CFR § 155.230 and a notification of the right to request a fair hearing as set forth in COMAR 14.35.11.04.

B. If an employee enrolls in a QHP with APTC or CSR, the Individual Exchange shall notify the employee's employer at the employer's address provided by the employee to the Individual Exchange that the employee has been determined eligible for APTC or CSR.

C. The notice under §B of this regulation shall:

(1) Identify the employee by including:

(a) The employee's name;

(b) The employee's date of birth;

(c) The last four digits of the employee's Social Security number, if available; and

(d) The employee's Individual Exchange identification number;

(2) Indicate that the employee has been determined eligible for APTC or CSR and has enrolled in a QHP;

(3) Indicate that if the employer has 50 or more full-time employees, the employer may be liable for the shared responsibility payment assessment set forth in § 4980H of the Internal Revenue Code; and

(4) Notify the employer of the employer's right to appeal the determination to HHS.

D. The Exchange shall send a notice to an applicant who submits an application containing insufficient information for the Exchange to conduct an eligibility determination, which shall:

(1) Indicate that the information necessary to complete an eligibility determination is missing;

(2) Specify the missing information;

(3) Provide instructions on how to provide the missing information to the Individual Exchange; and

(4) Specify that the applicant shall have 90 days to provide the missing information to the Individual Exchange beginning by the date of the notice.

E. If the applicant or enrollee has designated an authorized representative under Regulation .20 of this chapter, the Individual Exchange shall provide:

(1) Information regarding the powers and duties of authorized representatives to both the applicant or enrollee and to the authorized representative; and

(2) Notices to the applicant or enrollee and to the authorized representative.

F. The Individual Exchange shall provide written notice electronically to the individual if:

(1) The individual elects to receive notices electronically;

(2) The individual is mailed confirmation of the individual's election to receive notices electronically;

(3) The individual is informed of the right to change the election;

(4) The Individual Exchange posts notices in the individual's online Individual Exchange account within 1 business day of generation of the electronic notice; and

(5) Within 1 business day of generating the electronic notice, the Individual Exchange alerts the individual, via email to the individual's verified email address, to the existence of the electronic notice in the individual's online Individual Exchange account.

G. If the electronic communication under §F(5) of this regulation fails to be sent to the individual, the Individual Exchange shall mail a written notice of the failed electronic communication to the individual's mailing address.

H. An individual may request a written copy of any electronic notice the individual receives from the Individual Exchange.

Md. Code Regs. 14.35.07.04

Regulation .04 adopted effective 46:5 Md. R. 306, eff. 3/11/2019