Md. Code Regs. 31.17.03.10-1

Current through Register Vol. 51, No. 22, November 1, 2024

Section 31.17.03.10-1 - Low-Income Subsidy

A. The Board may subsidize the premiums, deductibles, and other expenses of an individual based on the individual's income if the individual:

(1) Is enrolled, or eligible to enroll, in the Plan;

(2) Has an annual household income that is at or below a percentage of the federal poverty level established by the Board;

(3) Submits to the plan administrator an application for the low-income subsidy on the form required by the Board; and

(4) Provides to the plan administrator verification of annual household income in a form acceptable to the Board.

B. Initial Application.

(1) An individual may apply for a low-income subsidy at any time.

(2) If an applicant for a low-income subsidy fails to provide all of the required documentation, the plan administrator shall notify the applicant of:

(a) The additional documentation that is required; and

(b) The deadline set by the plan administrator for receipt of the additional documentation.

(3) If the applicant fails to provide the additional documentation by the deadline:

(a) The plan administrator shall notify the applicant that the applicant has not demonstrated eligibility for the low-income subsidy and bill the applicant for standard Plan enrollment; and

(b) The applicant shall reapply for a low-income subsidy if the applicant wishes to receive future consideration for a low-income subsidy.

C. Recertification.

(1) Each year, the plan administrator shall mail a low-income subsidy recertification form to each member currently receiving a low-income subsidy.

(2) The form shall require the member to provide to the plan administrator updated verification of annual household income:

(a) In a form acceptable to the Board; and

(b) That demonstrates continued eligibility for the low-income subsidy.

(3) If a member who is receiving a low-income subsidy fails to demonstrate continued eligibility for the low-income subsidy, the member may select a standard Plan design option during open enrollment.

(4) If a member who fails to demonstrate continued eligibility for the low-income subsidy fails to select a standard Plan design option during open enrollment, the plan administrator shall place the member in a Plan design option in accordance with standards established by the Board.

D. Enrollment Capacity.

(1) The Board shall determine the number of members who may receive the low-income subsidy each year.

(2) If the Board determines that the maximum number of members are receiving the low-income subsidy for a year, the plan administrator shall:

(a) Discontinue granting the low-income subsidy; and

(b) Establish a waiting list of individuals who are eligible for the low-income subsidy.

(3) An individual on the waiting list may enroll in a standard Plan design option until a low-income subsidy becomes available to the individual.

E. Fraud.

(1) The plan administrator immediately shall cease the low-income subsidy to a member if the plan administrator determines that the member received the low-income subsidy based on fraudulent documentation or statements, including any material misrepresentation but for which the member would not have received the low-income subsidy.

(2) The Plan may recover from any member or former member the amount of any low-income subsidy that the member or former member received due to the Plan's reliance on a material misrepresentation by the member or former member.

Md. Code Regs. 31.17.03.10-1

Regulation .10-1 adopted effective May 21, 2007 (34:10 Md. R. 891)