Md. Code Regs. 14.35.14.07

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

Section 14.35.14.07 - Termination by Carrier

A. A carrier may only terminate an individual's coverage in a QHP before receiving an instruction from the Exchange to terminate coverage:

(1) If the enrollee requests termination of the enrollee's enrollment to the carrier, and the termination follows the procedures in Regulation .04 of this chapter;

(2) If the enrollee's coverage is rescinded under 45 CFR § 147.128;

(3) If the carrier is decertified by the Exchange under COMAR 14.35.16.11;

(4) If the carrier ceases to offer the QHP that an enrollee is enrolled in through the Exchange under 45 CFR § 147.106(b)(4) and the carrier follows the requirements under 45 CFR § 147.106(c);

(5) If the carrier ceases to offer any QHPs through the Exchange under 45 CFR § 147.106(b)(4) and the carrier follows the requirements under 45 CFR § 147.106(d);

(6) If the enrollee has performed an act or practice that constitutes fraud or intentional misrepresentation of material fact in connection with the coverage under 45 CFR § 147.106(b)(2); or

(7) For nonpayment of premiums as specified in §B of this regulation.

B. Termination for Nonpayment.

(1) A carrier may terminate coverage for nonpayment of premium if the enrollee has not made applicable premium payments and at the time the enrollee first fails to pay premiums:

(a) The enrollee is receiving APTC, and the 3-month grace period under Insurance Article, § 15-1315(c) -(e), Annotated Code of Maryland, has been exhausted; or

(b) The enrollee is not receiving APTC and all other applicable grace periods under State law have been exhausted.

(2) A carrier may not terminate coverage for failure to make a premium payment if:

(a) Through a renewal of the plan under 45 CFR § 155.335, the enrollee maintains coverage in the same QHP or same product that is a uniform modification of coverage under Insurance Article, § 15-1309(a)(4), Annotated Code of Maryland; and

(b) The applicable grace period has not been exhausted under:

(i) Insurance Article, § 15-1315(c) -(e), Annotated Code of Maryland; or

(ii) Another applicable grace period under State law if the enrollee is not receiving APTC.

(3) The last day of coverage is:

(a) The last day of the first month of the 3-month grace period when terminating an individual after exhaustion of the 3-month grace period for individuals receiving APTC; and

(b) 31 days after the missed premium payment was due when terminating an individual after the exhaustion of any other applicable grace period.

C. Notice of Non-Payment of Premiums.

(1) If an enrollee is delinquent on premium payment, the carrier shall provide the enrollee with notice of such payment delinquency. A carrier shall provide such notices promptly and without undue delay, within 10 business days of the date the issuer should have discovered the delinquency.

Md. Code Regs. 14.35.14.07

Regulation .07 adopted effective 42:11 Md. R. 726, eff.6/8/2015; adopted effective 46:5 Md. R. 308, eff. 3/11/2019; amended effective 51:3 Md. R. 154, eff. 2/19/2024.