Md. Code Regs. 14.35.19.06

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

Section 14.35.19.06 - Disbursement of Subsidies

A. The Individual Exchange shall transmit subsidies directly to the carrier with whom the recipient is enrolled, to be applied to the recipient's premium.

B. A carrier that receives notice from the Individual Exchange that an individual enrolled in the carrier's QHP is eligible for subsidies shall:

(1) Reduce the portion of the premium charged to or for the individual for the applicable month or months by the amount of the subsidy;

(2) Notify the Exchange of the reduction in the portion of the premium charged to the individual in accordance with 45 CFR § 156.265(g); and

(3) Include with each billing statement, as applicable, to or for the individual the amount of the subsidy for the applicable month or months, and the remaining premium owed.

C. Refunds.

(1) If a carrier discovers that it did not reduce the portion of the premium charged to or for an enrollee for the applicable month or months by the amount of the subsidy in accordance with §B(1) of this regulation, the carrier shall notify the enrollee of the improper reduction within 45 calendar days of the carrier's discovery of the improper reduction and refund any excess premium paid by or for the enrollee.

(2) Unless a refund is requested by or for the enrollee, the carrier shall, within 45 calendar days of discovery of the error, apply the excess premium paid by or for the enrollee to the enrollee 's portion of the premium or refund the amount directly.

(3) If any excess premium remains after application of premium as described in §C(2) of this regulation:

(a) The carrier shall apply the excess premium to the enrollee's portion of the premium for each subsequent month for the remainder of the period of enrollment or benefit year until the excess is fully applied or refund the remaining amount directly; and

(b) At the end of the period of enrollment or benefit year, the carrier shall refund any excess premium within 45 calendar days of the end of the period of enrollment or benefit year, whichever comes first.

(4) If a refund is requested by or for the enrollee, the refund shall be provided within 45 calendar days of the date of the request.

D. A carrier may not refuse to commence coverage under a policy or terminate coverage on account of any delay in payment of a subsidy on behalf of an enrollee if the carrier has been notified by the Exchange that the carrier will receive such advance payment.

E. Carriers shall participate in the payment and reconciliation process established by the Individual Exchange to ensure that appropriate payments are received by the carriers and that excess payments are returned by the carriers to the Individual Exchange.

Md. Code Regs. 14.35.19.06

Regulation .06 adopted effective 48:24 Md. R.1025, eff. 11/29/2021