Section 220-RICR-90-00-1.10 - Termination of Coverage and Grace PeriodsA. Termination of Coverage 1. In General - §1412(c)(2) of the ACA, and its implementing regulation, 45 C.F.R. § 156.270, incorporated above at § 1.3 of this Part, establish a three (3) month grace period for non-payment of premium before coverage will be terminated for a qualified individual who is receiving advance payment of premium tax credits and has made at least one (1) full month's premium payment during the Benefit Year. 45 C.F.R. § 155.430, incorporated above at § 1.3 of this Part, establishes procedures for termination of QHP coverage.2. Termination of Coverage Due to Non-Payment of Premium - The Exchange shall establish a standard policy for the termination of coverage of enrollees due to non-payment of premiums. This policy for the termination of coverage: a. Must include the grace period for enrollees receiving advance payments of the premium tax credits; andb. Must be applied uniformly to enrollees in similar circumstances.B. Grace Periods 1. Individuals Receiving an Advance Premium Tax Credit - The Exchange shall provide a grace period of three (3) consecutive months if an enrollee eligible to receive advance payments of the premium tax credit has previously paid at least one (1) full month's premium during the Benefit Year.2. Exhaustion of Grace Period - If an enrollee receiving advance payments of the premium tax credit exhausts the three (3) month grace period without paying all outstanding premiums, the Exchange shall terminate the enrollee's coverage. Coverage is terminated with retrospective effect to the last day of the first (1st) month of the three (3) month grace period.3. The QHP issuer must continue to pay claims during the first (1st) month of the grace period and may pend claims during the second (2nd) and third (3rd) months of the grace period.4. The Exchange has the authority to extend a grace period on a case-by-case basis.C. Qualified Health Plan Issuers May Not Terminate Coverage - If a Qualified Health Plan issuer believes coverage should be terminated, it must request a termination from the Exchange, in a manner prescribed by the Exchange.D. Involuntary Termination - The Exchange may promptly initiate termination upon any of the following events: 1. The enrollee is no longer a qualified individual as determined based on information submitted by the enrollee or information obtained by the Exchange or whose eligibility changes such that they are eligible for a different QHP.3. Non-payment of premiums, after the exhaustion of any applicable grace period.4. The QHP has been decertified, which constitutes a loss of Minimum Essential Coverage. The qualified enrollee will be given an opportunity to enroll in a new QHP pursuant to special enrollment periods set forth in § 1.6(D) of this Part.5. The qualified individual selects a different QHP during an open or special enrollment period.E. Voluntary Termination - The Exchange shall terminate enrollment at any time upon the request of an enrollee. Effective termination dates for voluntary termination shall be established by the Exchange.F. Notice - The Exchange will provide an enrollee written notice of an involuntary termination that shall include the basis of the termination.G. Effective Date of Termination 1. Voluntary terminations - Upon submitting a valid voluntary termination request, coverage shall terminate on the last day of the month in which the request is made. The Exchange has discretion to grant an earlier termination date, on a case-by-case basis.2. Involuntary terminations - If the enrollee is no longer a qualified individual as determined upon receipt of information from the enrollee or information obtained by the Exchange, coverage will terminate in accordance with 45 C.F.R. § 155.430, incorporated above at § 1.3 of this Part.220 R.I. Code R. § 220-RICR-90-00-1.10
Amended effective 12/22/2019
Amended effective 12/31/2020
Amended effective 4/2/2023