Md. Code Regs. 14.35.18.05

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

Section 14.35.18.05 - Termination, Cancellation, and Renewal of Qualified Health Plan

A. Termination.

(1) A qualified employer who participates in the SHOP and who terminates SHOP coverage terminates the enrollment of the employees enrolled in plans under the SHOP.

(2) An employee who is the certificate holder of a qualified health plan purchased through the SHOP, who terminates enrollment in a qualified health plan also terminates the enrollment of the other enrollees in the employee's household.

(3) Each enrollee who is not the certificate holder may terminate enrollment in a qualified health plan without affecting the enrollment status of the employee's household or each individual member of the employee's household other than the enrollee.

(4) A carrier shall process the SHOP Exchange's termination determination promptly and without undue delay.

(5) A carrier shall maintain records of termination of enrollment in a qualified health plan in the format specified by the SHOP Exchange in an electronic data interchange format for a period of 10 years.

(6) A carrier shall make reasonable accommodations for all individuals with disabilities (as defined by the Americans with Disabilities Act), including head-of-household and non-head-of-household enrollees, before terminating the individual's enrollment.

(7) A carrier shall send an electronic transaction to the SHOP Exchange documenting, or acknowledging, each termination of coverage carried out under this chapter, promptly and without undue delay.

B. Termination by the SHOP Exchange.

(1) Termination Due to Failure to Pay.

(a) If payment for a group is not received by the end of the grace period stated in the group contract, the SHOP Exchange may terminate the group's coverage.

(b) The last day of coverage shall be the last day of the grace period stated in the group contract or first day of the coverage month.

(2) Termination Due to Error, Misconduct, Fraud, or Misrepresentation of a Group. Coverage may be retroactively terminated if:

(a) The enrollment in a qualified health plan through the SHOP Exchange was unintentional, inadvertent, or erroneous and was the result of the error or misconduct of an officer, employee, or agent of the SHOP Exchange, its instrumentalities, or a non-Exchange entity providing enrollment assistance or conducting enrollment activities;

(b) The employee or group was enrolled in a qualified health plan without the employee or group's knowledge or consent by any third party, including third parties who have no connection with the SHOP Exchange; or

(c) The eligibility determination was made based on information regarding the group that is false or misrepresentative of the actual composition of the group.

(3) Notification of Termination.

(a) If any employee's coverage or enrollment through the SHOP is terminated due to nonpayment of premiums or due to a loss of the employee's eligibility to participate in the SHOP, including the coverage of an employee who loses eligibility because a qualified employer has lost its eligibility, the SHOP shall notify the employee of the termination.

(b) Such notice of termination shall include the termination effective date and reason for termination, and shall be sent within 3 business days if an electronic notice is sent, and within 5 days if a mailed hard copy notice is sent.

C. Renewal, Nonrenewal, and Cancellation. Renewal, nonrenewal, and cancellation shall be conducted in accordance with the requirements of Insurance Article, § 15-1212, Annotated Code of Maryland.

Md. Code Regs. 14.35.18.05

Regulation .05 adopted effective 46:22 Md. R. 976, eff. 11/4/2019