Md. Code Regs. 14.35.15.06

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

Section 14.35.15.06 - Conditions for Participation - Individual Exchange Premium Payment

A. An authorized carrier shall follow the premium payment procedures and deadlines under COMAR 14.35.07.11F.

B. An authorized carrier may establish a premium payment threshold policy under COMAR 14.35.07.11G

C. An authorized carrier may not use a payment made to effectuate coverage under COMAR 14.35.07.11F(1) to pay outstanding balances attributed to previously terminated coverage of the qualified individual.

D. An authorized carrier in the Individual Exchange shall calculate that the premium for coverage lasting less than 1 month equals the product of:

(1) The premium for 1 month of coverage divided by the number of days in the month; and

(2) The number of days for which coverage is being provided in the month.

E. An authorized carrier shall accept premium and cost-sharing payments from the following third-party entities:

(1) Ryan White HIV/AIDS Program under Title XXVI of the Public Health Service Act;

(2) Indian tribes, tribal organizations, or urban Indian organizations; and

(3) State and federal government programs.

F. Establishment of Standard Policies for Termination of QHPs Due to Non-payment of Premiums.

(1) An authorized carrier shall establish a standard policy for termination of enrollment of enrollees through the Exchange due to non-payment of premiums under COMAR 14.35.14.06B.

(2) The authorized carrier's standard policy shall:

(a) Include the grace period for enrollees receiving Advanced Premium Tax Credits set forth in Insurance Article, § 15-1315(c) -(e), Annotated Code of Maryland;

(b) Include the grace period for enrollees not receiving an Advanced Premium Tax Credit set forth in Insurance Article, § 15-209, Annotated Code of Maryland, COMAR 31.10.25.04C, and COMAR 31.12.07.05D;

(c) Be applied uniformly to enrollees in similar circumstances;

(d) Specify whether the authorized carrier has a premium payment threshold policy under COMAR 14.35.07.11G; and

(e) If the carrier has a premium payment threshold policy, specify the authorized carrier's premium payment threshold policy.

G. location of Premium Payment Information.

(1) An authorized carrier shall make information available to enrollees through an Internet link that is displayed prominently in the enrollee's authorized carrier's monthly premium payment billing notice.

(2) This information shall be available on:

(a) The authorized carrier's enrollee website;

(b) The authorized carrier's enrollee Internet portal; and

(c) Upon request by an enrollee.

Md. Code Regs. 14.35.15.06

Regulation .06 adopted effective 46:5 Md. R. 308, eff. 3/11/2019; amended effective 51:3 Md. R. 154, eff. 2/19/2024.