Md. Code Regs. 14.35.07.23

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

Section 14.35.07.23 - QHP Re-Enrollments-In General

A. The Exchange shall redetermine the eligibility of a qualified individual on an annual basis as specified in 45 CFR § 155.335.

B. The Exchange shall provide a qualified individual with an annual redetermination notice as specified in 45 CFR § 155.335(c) that adheres to the timing specified in 45 CFR § 155.335(d).

C. If an enrollee remains eligible for enrollment in a QHP through the Exchange upon annual redetermination, the Exchange shall re-enroll the enrollee according to 45 CFR § 155.335(j), except as provided for in §E of this regulation.

D. Consumers eligible for re-enrollment may:

(1) Change their plan during open enrollment;

(2) If ineligible for automatic re-enrollment, manually re-enroll coverage by:

(a) Re-enrolling online through the Maryland Health Connection Consumer Portal;

(b) Re-enrolling with the assistance of an Individual Exchange Navigator, certified application counselor, or insurance producer; or

(c) Calling the MHC call center; or

(3) Decline re-enrollment.

E. Re-Enrollment into Higher Value Plans.

(1) Unless the enrollee terminates coverage, including termination of coverage in connection with voluntarily selecting a different QHP in accordance with 45 CFR § 155.430, the exchange shall follow the procedure detailed in §E(2) of this regulation to re-enroll an enrollee into a plan other than the enrollee's original plan or plan identified by the carrier pursuant to §F of this regulation if the enrollee:

(a) Remains eligible for enrollment in a QHP through the Exchange upon annual redetermination;

(b) Is determined, upon annual redetermination, eligible for cost-sharing reductions in accordance with 45 CFR § 155.305(g);

(c) Is currently enrolled in a bronze level QHP that is not a high deductible health plan compatible with a health savings account as defined in 26 U.S.C. § 223; and

(d) Would be re-enrolled in a bronze level QHP that is not a high deductible health plan compatible with a health savings account as defined in 26 U.S.C. § 223 under §B of this regulation.

(2) The Exchange shall re-enroll enrollees that meet the criteria of §E(1) of this regulation in the QHP:

(a) With the highest actuarial value available;

(b) Within the same product;

(c) With the same provider network; and

(d) Which, compared to the original bronze level QHP into which the Exchange would otherwise re-enroll the enrollee under §B of this regulation, and after the application of advance payment of the premium tax credit and young adult subsidy under COMAR 14.35.19, has a premium that is:

(i) Lower; or

(ii) Equivalent.

F. For QHPs that carriers plan to discontinue, enrollees in those QHPs shall be re-enrolled into QHPs determined by carrier-submitted plan reenrollment templates according to COMAR 14.35.15.05O.

Md. Code Regs. 14.35.07.23

Regulation .23 adopted effective 51:15 Md. R. 710, eff. 8/5/2024.