Md. Code Regs. 14.35.14.05

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

Section 14.35.14.05 - Enrollee-Initiated Terminations-Due to Error, Misconduct, or Enrollment without Knowledge or Consent

A. An enrollee may retroactively terminate the enrollee's coverage when:

(1) The enrollee attempted to terminate the enrollee's coverage and the enrollee experienced a technical error that did not allow the enrollee to terminate the enrollee's coverage;

(2) The enrollee's enrollment in a QHP through the Exchange was unintentional, inadvertent, or erroneous and was the result of the error or misconduct of an officer, employee, or agent of the Exchange, its instrumentalities, or a non-Exchange entity providing enrollment assistance or conducting enrollment activities; or

(3) The enrollee was enrolled in a QHP without the enrollee's knowledge or consent by any third party, including third parties who have no connection with the Exchange.

B. Misconduct under §A(2) of this regulation means the failure of an officer, employee, or agent of the Exchange, its instrumentalities, or a non-Exchange entity providing enrollment assistance or conducting enrollment activities to comply with applicable standards under COMAR 14.35.14 or other applicable State or federal laws as determined by the Exchange.

C. Except as specified in §D of this regulation, the enrollee shall request termination under §A of this regulation by notifying the Exchange of the request:

(1) Within 60 days of discovering the technical error under §A(1) of this regulation;

(2) Within 60 days of discovering the unintentional, inadvertent, or erroneous enrollment under §A(2) of this regulation; or

(3) Within 60 days of discovering the enrollment under §A(3) of this regulation.

D. If the enrollee discovers an enrollment under §A of this regulation in the previous calendar year, the enrollee shall request termination under §A of this regulation by notifying the Exchange of the request by the end of March the calendar year immediately following the calendar year with the enrollment under §A of this regulation.

E. Notification to the Exchange under §§C and D of this regulation shall be satisfied if the enrollee provides notice:

(1) To an Exchange-certified navigator, an Exchange-authorized broker, or an Exchange-certified consolidated service center representative; and

(2) Using any of the methods of communication listed under COMAR 14.35.07.03B.

F. The effective date of the termination under §A of this regulation shall be:

(1) For a retroactive termination under §A(1) of this regulation, no later than the end of the month when the enrollee contacted the Exchange to request termination of the enrollee's enrollment through the Exchange; and

(2) For a retroactive termination under §A(2) or (3) of this regulation:

(a) The original coverage effective date; or

(b) A later date, as determined appropriate by the Exchange, based on the circumstances of the termination.

Md. Code Regs. 14.35.14.05

Regulation .05 adopted effective 42:11 Md. R. 726, eff.6/8/2015; adopted effective 46:5 Md. R. 308, eff. 3/11/2019