Md. Code Regs. 14.35.12.05

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

Section 14.35.12.05 - Application Procedures

A. In order to obtain an application counselor sponsoring entity designation, the applicant shall submit to the Maryland Health Benefit Exchange:

(1) An application on the form approved by the Maryland Health Benefit Exchange in consultation with the Commissioner and the Department of Health and Mental Hygiene;

(2) An attestation that the applicant will notify the Maryland Health Benefit Exchange of any changes in information the applicant provides or to which the applicant attests on the application form within 30 days of such change;

(3) An attestation that the applicant will not impose a fee on individuals for services provided by certified application counselors employed or engaged by the applicant;

(4) An attestation that the applicant will disclose to the Maryland Health Benefit Exchange and to individuals to whom certified application counselors employed or engaged by the applicant provide services any relationships it has with a carrier, an insurance producer, or a third-party administrator or a managed care organization that participates in the Maryland Medical Assistance Program/Maryland Children's Health Program;

(5) An attestation that the applicant will act in the best interest of the individuals for whom the certified application counselors employed or engaged by the applicant are authorized to provided services;

(6) An attestation that the applicant will not receive compensation from a carrier, insurance producer, managed care organization, or a third-party administrator for application counselor services provided by certified application counselors employed or engaged by the applicant;

(7) An attestation that the applicant will compensate employed or engaged certified application counselors in the manner approved by the Maryland Health Benefit Exchange working in consultation with the Commissioner and the Department of Health and Mental Hygiene;

(8) An attestation that the applicant will not directly or through employed or engaged certified application counselors provide monetary or other financial incentives to individuals to apply for health insurance coverage through Maryland Health Connection;

(9) An attestation that the applicant will not receive compensation from the Maryland Health Benefit Exchange for certified application counselor services;

(10) An attestation that the applicant will monitor the performance of its certified application counselors in accordance with the requirements set forth by the Maryland Health Benefit Exchange;

(11) An attestation that the applicant will enforce the required agreement set forth under Regulation .03D of this chapter;

(12) An attestation that the applicant will oversee employed or engaged certified application counselors pursuant to the oversight plan approved by the Maryland Health Benefit Exchange, in consultation with the Commissioner and the Department of Health and Mental Hygiene;

(13) An attestation that the applicant will comply with all applicable federal and State privacy and security standards, and will ensure that its certified application counselors also comply with these standards;

(14) An attestation that the applicant will operate within its scope of authority and ensure that it and its certified application counselors comply with the requirements set forth under Regulation .04 of this chapter;

(15) An attestation that the applicant will comply with any applicable requirements of Department of Health and Mental Hygiene and the Commissioner; and

(16) An application fee to the extent permitted by law and in the manner specified by the Maryland Health Benefit Exchange, if applicable.

B. The Maryland Health Benefit Exchange may not consider an application to be complete until it has received all required materials.

C. If the application is not completed with all required materials within 45 days after the Maryland Health Benefit Exchange receives the signed application form, the Maryland Health Benefit Exchange may consider the application withdrawn.

D. The Maryland Health Benefit Exchange shall approve or deny an application within 45 days after its completion and receipt of all required materials.

E. Approval of an application will be contingent on the applicant's execution of a designation agreement, in the form presented by the Maryland Health Benefit Exchange working in consultation with the Commissioner and the Department of Health and Mental Hygiene.

F. The Maryland Health Benefit Exchange may exercise its discretion in approving an application and designating an entity as an application counselor sponsoring entity, taking into consideration:

(1) The applicant's ability to satisfy the requirements set forth in the application; and

(2) The resources, oversight capacity, and needs of the Maryland Health Benefit Exchange, the Connector Program, the Maryland Insurance Administration, the Department of Health and Mental Hygiene, and other outreach and enrollment efforts.

Md. Code Regs. 14.35.12.05

Regulation .05 adopted effective 42:11 Md. R. 726, eff.6/8/2015; amended effective 47:12 Md. R. 597, eff. 6/15/2020