Md. Code Regs. 14.35.07.13

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

Section 14.35.07.13 - Special Enrollment Periods - Change in Family Status Through the Individual Exchange

A. A qualified individual, an enrollee, a qualified individual's dependent, and an enrollee's dependent are eligible for a special enrollment period for change in family status if the qualified individual or enrollee gains a dependent or becomes a dependent through:

(1) Marriage;

(2) Birth;

(3) Adoption;

(4) Placement for adoption;

(5) Placement in foster care;

(6) A child support order; or

(7) Other court order.

B. An enrollee is eligible for a special enrollment period for change in family status if the enrollee loses a dependent or is no longer considered a dependent through:

(1) Divorce;

(2) legal separation; or

(3) Death.

C. Family status changes shall be determined in accordance with the law of the state where the change in family status occurred.

D. If eligible for a special enrollment period under this regulation, a qualified individual, an enrollee, a qualified individual's dependent or an enrollee's dependent shall select a QHP within 60 days of the change in family status under §§A and B of this regulation.

E. Enrollment in a QHP selected by a qualified individual, an enrollee, the qualified individual's dependent, or the enrollee's dependent during a special enrollment period under this regulation shall be effective:

(1) For marriages, the first day of the month following the date that the Individual Exchange receives the QHP selection;

(2) For birth, adoption, placement for adoption, placement in foster care, or court order, on a date chosen by the qualified individual or enrollee that is either:

(a) The date of birth, adoption, placement for adoption, placement in foster care, or effective date of court order; or

(b) The first day of the month following the date that the Individual Exchange receives the QHP selection;

(3) In the case of death, the first day of the month following the date that the Individual Exchange receives the QHP selection; and

(4) For divorces or legal separation:

(a) The first date of the following month for QHP selections received by the Individual Exchange between the first and the 15th day of the month; or

(b) The first day of the next following month for QHP selections received by the Individual Exchange between the 16th and the last day of a month.

Md. Code Regs. 14.35.07.13

Regulation .13 adopted effective 46:5 Md. R. 306, eff. 3/11/2019; amended effective 49:12 Md. R.642, eff. 6/13/2022