Md. Code Regs. 14.35.07.18

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

Section 14.35.07.18 - Special Enrollment Period - Permanent Move

A. A qualified individual, enrollee, qualified individual's dependent, or enrollee's dependent is eligible for a special enrollment period if the qualified individual, enrollee, qualified individual's dependent, or enrollee's dependent:

(1) Gains access to a new QHP as a result of a permanent move;

(2) Was enrolled in minimum essential coverage for one or more days in the 60 days prior to the move, unless the qualified individual, enrollee, qualified individual's dependent, or enrollee's dependent:

(a) lived in a foreign country or a United States territory for 1 or more days during the 60 days preceding the date of the move;

(b) Is moving from a state that did not expand Medicaid or MCHP eligibility set forth in § 2001 of the ACA and the individual was not eligible for APTC or CSR in the individual's previous state of residence because the individual's household income was below 100 percent of the FPL;

(c) Is leaving incarceration, except if the individual was incarcerated pending disposition;

(d) Lived in a service area where no QHP was available through the Exchange for 1 or more days during the 60 days preceding the move or during the most recent preceding open enrollment or special enrollment period;

(e) Had pregnancy related coverage or access to healthcare services through unborn child coverage described in 45 CFR § 155.420(d) (1)(iii);

(f) Had medically needy coverage described in 45 CFR § 155.420(d)(1)(iv); or

(g) Is an Indian; and

(3) Notifies the Individual Exchange within 60 days from the date of the permanent move that the qualified individual, the enrollee, the qualified individual's dependent, or the enrollee's dependent has gained access to a new QHP as a result of that move.

B. A permanent move does not include:

(1) A short-term or temporary move where the qualified individual, the enrollee, the qualified individual's dependent, or the enrollee's dependent does not intend to remain in the individual's new location; or

(2) A move solely for the purpose of obtaining medical treatment.

C. A qualified individual, enrollee, qualified individual's dependent, or enrollee's dependent may select a qualified health plan within 60 days of the date of the permanent move if the individual is otherwise eligible for the special enrollment period.

D. The effective date of coverage for a qualified individual, enrollee, qualified individual's dependent, or enrollee's dependent who is determined eligible for the special enrollment period under this regulation and selects enrollment in a QHP during the special enrollment period under §C of this regulation shall be:

(1) The first day of the month following the date of the permanent move for QHP selections received by the Individual Exchange on or before the date of the permanent move; or

(2) The first day of the following month for QHP selections received by the Individual Exchange after the date of the permanent move.

Md. Code Regs. 14.35.07.18

Regulation .18 adopted effective 46:5 Md. R. 306, eff. 3/11/2019; amended effective 49:12 Md. R.642, eff. 6/13/2022