Md. Code Regs. 10.25.01.05

Current through Register Vol. 51, No. 12, June 14, 2024

Section 10.25.01.05 - Employee Eligibility

A. An eligible employee of a small employer is eligible to receive the premium subsidy if, at the time of initial application and at the time of each renewal application:

(1) The small employer meets the requirements of Regulation .04 of this chapter;

(2) The eligible employee enrolls in a health benefit plan offered by the small employer;

(3) The eligible employee completes and signs the subsidy application; and

(4) The eligible employee complies with the regulations of this chapter.

B. An eligible employee applying for a premium subsidy for other than individual coverage shall satisfy the conditions described in Regulation .06 of this chapter.

C. At the time of initial application for the premium subsidy and at the time of each renewal application, each employee subsidy applicant shall complete, sign, and submit to a licensed insurance producer a form designated by the Commission which includes the following information:

(1) The type of coverage selected by the employee subsidy applicant;

(2) Information requested by the Commission about any insurance coverage carried by the employee subsidy applicant or the applicant's family members during the 3 months immediately before the employee subsidy applicant's initial application for the premium subsidy;

(3) Acknowledgement that the employee subsidy applicant's share of the premium will be deducted through a Section 125 payroll deduction plan;

(4) If other than individual coverage is sought, an affidavit regarding the family's adjusted gross income and an agreement to provide documentation of the family's adjusted gross income to the Commission on request; and

(5) Other information considered appropriate by the Commission.

D. Unless allowed under Regulation .08 of this chapter, the following individuals are ineligible to receive a premium subsidy:

(1) A former employee eligible for Continuation of Coverage under COMAR 31.11.04;

(2) Divorced spouses eligible for Continuation of Coverage under COMAR 31.11.02; and

(3) Surviving spouses eligible for Continuation of Coverage under COMAR 31.11.03.

Md. Code Regs. 10.25.01.05

Regulations .05 adopted as an emergency provision effective June 12, 2008 (35:14 Md. R. 1243); adopted permanently effective August 25, 2008 (35:17 Md. R. 1486)