Md. Code Regs. 14.35.14.06

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

Section 14.35.14.06 - Termination by the Exchange

A. A carrier shall terminate an enrollee's coverage in a qualified health plan upon receiving an electronic data transaction from the Exchange directing that the enrollee's coverage be terminated.

B. The Exchange shall direct the carrier to terminate an enrollee's enrollment in a QHP if:

(1) The enrollee is no longer eligible for coverage in a QHP through the Exchange;

(2) The enrollee requests termination under Regulations .04 and. 05 of this chapter;

(3) The enrollee's coverage is rescinded under 45 CFR § 147.128;

(4) The QHP terminates or is decertified under 45 CFR § 155.1080;

(5) The Exchange determines that:

(a) An enrollee was enrolled in a QHP without the enrollee's knowledge or consent by a third party, including by a third party with no connection with the Exchange; and

(b) Where possible, the Exchange has provided reasonable notice to the enrollee of the Exchange's determination;

(6) The enrollee changes from one QHP to another QHP during an annual open enrollment period under COMAR 14.35.07.11A(1) or a special enrollment period under COMAR 14.35.07.12-.19; and

(7) The enrollee moves outside of the service area under 45 CFR § 155.430(b)(2)(vii) in reference to 45 CFR 147.106(b)(5).

C. If the enrollee becomes eligible for other minimum essential coverage but does not request termination in accordance with Regulation .04 of this chapter at the time of plan renewal, the enrollee may choose to remain enrolled in a QHP without the provision of financial assistance through APTC or CSR payments.

D. If the enrollee does not choose to remain enrolled in the QHP through the Exchange when the enrollee becomes eligible for other minimum essential health coverage under §C of this regulation, the Exchange shall initiate termination of the enrollee's coverage upon completion of the redetermination process specified in 45 CFR § 155.330.

E. Upon termination by the Exchange, the last day of coverage by a QHP is:

(1) The last day of the enrollee's eligibility, if the Exchange determines an enrollee to be no longer eligible for coverage in a QHP through the Individual Exchange;

(2) The last day of the coverage month in which coverage is rescinded, if the enrollee's coverage is rescinded in accordance with 45 CFR § 147.128;

(3) The last day of the coverage month in which the QHP is terminated or decertified, if the QHP terminates or, as described in 45 CFR § 155.1080, is decertified;

(4) The last day of the coverage month in which the enrollee is determined newly eligible for enrollment in Medicaid or MCHP, if the enrollee chooses to terminate the QHP;

(5) The day before the first day of enrollment in the new QHP if an enrollee terminates coverage in a previous QHP and selects a new QHP during an annual open enrollment period under COMAR 14.35.07.11A(1) or a special enrollment period under COMAR 14.35.07.12-.19;

(6) The original coverage effective date for a cancellation under §B(5) of this regulation;

(7) The date of death, if the enrollee is terminated because of the enrollee's death; or

(8) The day before the change in the enrollee's circumstance if the enrollee is terminated because of a circumstance where the enrollee could not have prevented the disruption of the QHP enrollment.

F. For an enrollee's dependent turning age 26, the carrier may not terminate coverage of the dependent before the end of the coverage year in which the dependent reaches age 26.

Md. Code Regs. 14.35.14.06

Regulation .06 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.