Md. Code Regs. 14.35.18.04

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

Section 14.35.18.04 - Enrollment

A. Rolling Enrollment Period. A qualified employer may purchase coverage for its small group at any point during the year.

B. Length of Plan Year. The employer's plan year shall consist of the 12-month period beginning with the qualified employer's effective date of coverage.

C. Effective Coverage Dates.

(1) The effective date of coverage is:

(a) No later than the first day of the following month for a group enrollment received on the first through the fifteenth day of any month; or

(b) No later than the first day of the second following month for a group enrollment received on the sixteenth though the last day of any month.

(2) A qualified employer may opt for a later effective date within a quarter for which small group market rates are available.

D. Newly Hired Employees.

(1) The effective date of coverage for a qualified health plan selection received by the SHOP from a newly qualified employee is the first day of the month following the end of the waiting period.

(2) If the newly qualified employee makes a plan selection on the first day of the month and any applicable waiting period has ended by that date, coverage shall be effective on that date.

E. Annual Open Enrollment Period Standards. A carrier shall establish an open enrollment period that meets the requirements established under Insurance Article, §§ 15-1208.1 and 15-1208.2, Annotated Code of Maryland.

F. Eligibility Requirement Waiver Period. If a small group health plan cannot comply with group participation rules for the offering of health insurance coverage, a carrier may restrict the availability of such coverage to an annual enrollment period that begins November 15 and extends through December 15 of each calendar year.

G. Special Enrollment Periods. Special enrollment periods shall be established in accordance with the requirements of Insurance Article, §§ 15-1208.1 and 15-1208.2, Annotated Code of Maryland.

H. Waiting Period.

(1) A small employer may implement a waiting period of no more than 60 days for any qualified employee.

(2) Coverage will be effective the first of the month following the end of the waiting period.

I. Payment of First Month's Premium.

(1) A small employer shall pay the first month 's premium to the carrier of the qualified health plan to effectuate enrollment when the small employer has:

(a) Enrolled in a qualified health plan after coverage from a previous enrollment in a qualified health plan the individual had was terminated;

(b) Enrolled for the first time in a qualified health plan in the SHOP Exchange; or

(c) Enrolled in a qualified health plan offered by a different carrier of the same holding company in the SHOP Exchange.

(2) The first month's premium payment to effectuate prospective coverage for qualified health plan selections made during an annual open enrollment period or during a special enrollment period shall be due from the employer on a uniformly applied date specified by the authorized carrier of the qualified health plan that is no earlier than the coverage effective date but no later than 30 calendar days from the coverage effective date.

(3) The first month's premium payment to effectuate prospective coverage for qualified health plan selections made during a special enrollment period under §G of this regulation shall be due from the employer on a uniformly applied date specified by the authorized carrier of the qualified health plan that is no earlier than the coverage effective date but no later than 30 calendar days from the date the carrier receives the enrollment transaction from the SHOP.

(4) Payment to effectuate retroactive coverage shall include the premium due from the employer for all months of retroactive coverage and the full premium amount of the first prospective month of coverage.

(5) Payment to effectuate retroactive coverage for qualified health plan selections made during a special enrollment period shall be due on a uniformly applied date specified by the authorized carrier that is no earlier than the coverage effective date and no later than 30 calendar days from the date the carrier receives the enrollment transaction from the SHOP Exchange or the coverage effective date, whichever is later.

(6) An authorized carrier may choose to extend the premium due date if the carrier does so in a uniform and consistent manner for all similarly situated applicants.

J. Group Installation.

(1) A carrier shall install groups upon enrollment.

(2) Employee choice groups shall be effective on the date the group first effectuated coverage.

K. Renewal. A health insurance issuer offering SHOP coverage shall renew or continue in force the coverage in the manner prescribed under Insurance Article, § 15-1212, Annotated Code of Maryland.

Md. Code Regs. 14.35.18.04

Regulation .04 adopted effective 46:22 Md. R. 976, eff. 11/4/2019; amended effective 51:22 Md. R. 957-1028, eff. 11/11/2024.