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10.25.01.00.htm 10.25.01.00. Title 10 MARYLAND DEPARTMENT OF HEALTH Subtitle 25 MARYLAND HEALTH CARE COMMISSION Chapter 01 Small Employer Health Benefit Plan Premium Subsidy Program Authority: Insurance Article, §15-12A-01―15-12A-05, Annotated Code of Maryland
10.25.01.01.htm 10.25.01.01. 01 Scope.. A. This chapter only applies to the Small Employer Health Benefit Plan Premium Subsidy Program as authorized by Insurance Article, §15-12A-01―15-12A-05, Annotated Code of Maryland.B. Premium subsidies authorized under this chapter shall only be provided for health benefit plans that also comply with the provisions of COMAR 31.11.06.
10.25.01.02.htm 10.25.01.02. 02 Definitions.. A. In this chapter, the following terms have the meanings indicated.. B. Terms Defined.. 1) "Affiliated companies" means companies that are eligible to file a consolidated federal income tax return.2) "Average wage of business" means the average of the annual wage of all eligible employees; for each eligible owner, the wage used to calculate the average for the business shall be the lesser of:a) The eligible owner's countable wage; or.
10.25.01.03.htm 10.25.01.03. 03 Purpose.. The Premium Subsidy Program is designed to:. A. Provide an incentive for small employers to offer and maintain a small employer health benefit plan for their employees;B. Help low and moderate wage employees of small employers afford health benefit plan premiums;. C. Promote access to health care services, particularly preventive health care services that might reduce the need for emergency room care and other acute care services; and
10.25.01.04.htm 10.25.01.04. 04 Employer Eligibility.. A. A small employer is eligible to receive a premium subsidy if, at the time of initial application for the premium subsidy, the employer:1) Meets the requirements under Insurance Article, §15-1203(b)i) Annotated Code of Maryland;. 2) Has been in operation for at least 12 months and, if required to file quarterly wage reports, has filed quarterly wage reports with the Maryland Department of Labor, Licensing, and Regulation for, at a minimum, the three c
10.25.01.05.htm 10.25.01.05. 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.
10.25.01.06.htm 10.25.01.06. 06 Employee Selection of Other Than Individual Coverage.. A. An eligible employee may apply for a premium subsidy for other than individual coverage if the eligible employee's family adjusted gross income does not exceed the maximum income for other than individual coverage.B. An eligible employee applying for a premium subsidy for other than individual coverage shall comply with requirements considered necessary by the Commission to verify the reported family adjusted gross income.
10.25.01.07.htm 10.25.01.07. 07 Initial Application and Enrollment.. A. Initial application for the Premium Subsidy Program shall be made according to the procedures designated by the Commission and published on the Commission's official website.B. The small employer shall complete an initial application published on the Commission's official website that includes the following:1) Information necessary to establish the eligibility of the small employer and the amount of the available subsidy;
10.25.01.08.htm 10.25.01.08. 08 Application and Enrollment of Additional Employees During the Policy Year.. A. A newly hired eligible employee of an enrolled employer, an employee who becomes an eligible employee during the policy year, or an eligible employee who qualifies for a special enrollment period under 29 U.S.C. §1181(f) is eligible to be enrolled in the Premium Subsidy Program during the policy year under the terms established at the beginning of the policy year, unless either:
10.25.01.09.htm 10.25.01.09. 09 Renewal Application.. A. The enrolled employer shall complete a renewal application published on the Commission's official website. The renewal application shall include:1) Information necessary to establish the eligibility of the employer and the amount of the available premium subsidy;2) An acknowledgement that the Commission may request that certain records be produced and made available;3) An affidavit signed by the enrolled employer that the information in the
10.25.01.10.htm 10.25.01.10. 10 Calculation of the Average Wage of Business.. A. The average wage of business is the average of the wage for each of the eligible employees of the business.B. For employees who are eligible owners, the wage used in calculating the average wage of business shall be the greater of the following:1) The lesser of:. a) The eligible owner's countable wage; or. b) The eligible owner's adjusted gross income; or. 2) The minimum countable wage.. C. For all other eligible
10.25.01.11.htm 10.25.01.11. 11 Calculation of the Premium Subsidy.. A. At the time of initial application for the Premium Subsidy Program, the premium subsidy is the lower of:1) The amount from the maximum subsidy table applicable for the average wage of business and the type of coverage chosen by the employee; or2) 50 percent of the sum of:. a) The premium for the type of coverage chosen by the eligible employee;. b) The employer's eligible HSA contribution, if any; and.
10.25.01.12.htm 10.25.01.12. 12 Change in Employer's Federal Employer Identification Number.. If the federal employer identification number of the employer changes, because the company changes its form of ownership or for any other reason, the company may petition the Commission for continued eligibility for the Premium Subsidy Program under the new federal employer identification number. The Executive Director shall rule on the petition within 14 days of the receipt of all information nec
10.25.01.13.htm 10.25.01.13. 13 Change of Participating Carrier by the Enrolled Employer.. A. If the enrolled employer elects to change coverage from one participating carrier to a different participating carrier at the time of policy renewal and premium subsidy renewal, the enrolled employer shall identify the new carrier in the renewal application.B. If the enrolled employer elects to change coverage from one participating carrier to a different participating carrier at any time other than the t
10.25.01.14.htm 10.25.01.14. 14 Payment of the Premium Subsidy.. A. Payment of the total premium subsidy is subject to the following:. 1) The total premium subsidy for each enrolled employer shall be paid to the subsidy administrator and shall reduce the total premium owed by the enrolled employer;2) The enrolled employer shall pass the employee premium subsidy to the enrolled employee in the form of reduced payroll deductions for the health benefit plan;3) The employee premium subsidy is calculated as t
10.25.01.15.htm 10.25.01.15. 15 Carrier Requirements.. A. To participate in the Premium Subsidy Program, a carrier shall meet the definition of a participating carrier under Regulation .02B(34) of this chapter.B. The written participation agreement shall include:. 1) The carrier's designation of its subsidy administrator or administrators;. 2) The Commission's requirement for monthly data submissions regarding premium subsidy recipients covered by the participating carrier; and3) The participating carr
10.25.01.16.htm 10.25.01.16. 16 Licensed Insurance Producer Requirements.. A licensed insurance producer in connection with the sale, solicitation, or negotiation of a health benefit plan to a small employer who meets the requirements described in Regulation .04 of this chapter shall:A. Provide information to the small employer about wellness benefits;. B. At the time of initial application or at the time of policy renewal, advise the small employer to consult a tax advisor about the tax advantages of
10.25.01.17.htm 10.25.01.17. 17 Premium Subsidy Program Design Factors.. A. At least once each year, the Commission shall publish on the Commission's official website for informal public comment a list of the proposed Premium Subsidy Program design factors, including:1) Eligible owner's countable wage;. 2) Employee's eligible HSA contribution;. 3) Maximum average wage for new applications;. 4) Maximum average wage for participants;. 5) Maximum eligible firm size;.
10.25.01.18.htm 10.25.01.18. 18 Closing the Premium Subsidy Program to the Entry of New Businesses.. A. The Executive Director may close the program to the entry of new businesses by closing the Commission registry to new registration, notifying the participating carriers, and posting notice on the Commission's official website.B. This action shall be taken when the subsidies for the coming year are projected to reach or exceed the subsidy program cap, and may be taken at other times for reasons that
10.25.01.19.htm 10.25.01.19. 19 Closing the Premium Subsidy Program to the Entry of Additional Employees of Enrolled Employers.. A. The Executive Director may close the Premium Subsidy Program to the entry of new employees by closing the Commission registry to registration of additional employees, notifying the participating carriers and enrolled employers, and posting notice on the Commission's official website.B. This action shall be reviewed by the Commission at its next meeting..
10.25.01.20.htm 10.25.01.20. 20 Reopening the Premium Subsidy Program.. A. Following closure of the Premium Subsidy Program under Regulation .18 or .19 of this chapter, the Commission may reopen the Premium Subsidy Program through a formal action specifying both the application process and the criteria that will be used to select new participants from among those applying. Selection criteria may include the average wage of the business, the geographic distribution of enrolled employers, or an
10.25.01.21.htm 10.25.01.21. 21 Penalties.. A. In any conduct relating to the Premium Subsidy Program, employers, employees, participating carriers, subsidy administrators, and licensed insurance producers are subject to criminal and civil penalties under applicable law for any knowing and willful making of a materially false or fraudulent statement and the knowing and willful use of a false or fraudulent document.B. Employers, employees, participating carriers, subsidy administrators, an
10.25.01.22.htm 10.25.01.22. 22 Decisions of the Commission ― Delegation of Program Administration to the Executive Director.. A. Decisions of the Commission relating to policies, regulations, and program design under Regulations .17―20 of this chapter may not be delegated.B. All other decisions of the Commission regarding program administration, including determinations of eligibility under Regulations .04, .05, .06, .12, and 13 of this chapter, subsidy calculations under Regulation .11 of thi
10.25.01.23.htm 10.25.01.23. 23 Appeals of Decisions of the Executive Director.. A. Decisions of the Executive Director may be appealed to the Commission.. B. The appeal shall be in writing and filed with the Commission within 30 days of the date of the decision of the Executive Director.C. The appeal shall state specifically the facts of the situation and the justification for the Commission to change the decision of the Executive Director. The appeal may:1) Present significant, relevant information that
10.25.01.24.htm 10.25.01.24. 24 Appeals of Decisions of a Participating Carrier.. Actions taken by a participating carrier, including actions taken by a participating carrier that affect a small employer's eligibility for participation in the Premium Subsidy Program or the amount of the premium subsidy, shall be handled through the customary appeals processes for carrier decisions and may not be appealed to the Commission.
10.25.01.9999.htm 10.25.01.9999. Administrative History Effective date:. Regulations .01―24 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)Regulation .02B amended as an emergency provision effective July 16, 2009 (36:17 Md. R. 1310) amended permanently effective October 19, 2009 (36:21 Md. R. 1591)Regulation .06D adopted as an emergency provision effective July 16, 2009 (36:17 Md. R. 1310) amende
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