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14.35.14.00.htm 14.35.14.00. Title 14 INDEPENDENT AGENCIES Subtitle 35 MARYLAND HEALTH BENEFIT EXCHANGE Chapter 14 Termination, Cancellation, and Rescission of Qualified Health Plan Authority: Insurance Article, §31-106(c)1)iv) and 31-108(b)1) and (6) Annotated Code of Maryland
14.35.14.01.htm 14.35.14.01. 01 Scope.. This chapter describes the events that may result in the termination, cancellation, or rescission of the enrollment of an individual enrolled in a QHP through the Individual Exchange.
14.35.14.02.htm 14.35.14.02. 02 Definitions.. A. In this chapter, the following terms have the meanings indicated.. B. Terms Defined.. 1) “Cancellation” means an action that ends a qualified individual's enrollment through the Exchange on the date such enrollment became effective resulting in enrollment through the Exchange never having been effective.2) “Product” has the meaning stated in Insurance Article, §15-1309(a)3)i) Annotated Code of Maryland.3) “Reinstatement” means a correction of an errone
14.35.14.03.htm 14.35.14.03. 03 Terminations in General.. A. An enrollee who is the contract holder of a QHP who terminates enrollment in a QHP also terminates the enrollment of the other enrollees in the household.B. Each enrollee, who is not the contract holder, may terminate enrollment in a QHP without affecting the enrollment status of the enrollee’s household or each individual member of the enrollee’s household other than the enrollee.C. A carrier shall process a request from the cont
14.35.14.04.htm 14.35.14.04. 04 Enrollee-Initiated Terminations ― In General.. A. An enrollee may terminate the enrollee’s coverage in a QHP at any time within a month for a termination effective at the end of the month.B. An enrollee may request a termination of the enrollee’s coverage in a QHP by providing notice to the Exchange or the enrollee’s QHP carrier as follows:1) Enrollees seeking to terminate coverage for an enrollee or enrollees on a QHP shall provide notice to the Exchange; and
14.35.14.05.htm 14.35.14.05. 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
14.35.14.06.htm 14.35.14.06. 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;.
14.35.14.07.htm 14.35.14.07. 07 Termination by Carrier.. A. A carrier may only terminate an individual’s coverage in a QHP before receiving an instruction from the Exchange to terminate coverage:1) If the enrollee requests termination of the enrollee’s enrollment to the carrier, and the termination follows the procedures in Regulation .04 of this chapter;2) If the enrollee’s coverage is rescinded under 45 CFR §147.128;. 3) If the carrier is decertified by the Exchange under COMAR 14.35.16.11;.
14.35.14.08.htm 14.35.14.08. 08 Cancellation.. A. An individual’s enrollment in a QHP may be canceled only if:. 1) The enrollee requests voluntary cancellation of the enrollee’s enrollment to the Exchange or the carrier under §C of this regulation;2) The enrollee’s coverage is rescinded under 45 CFR §147.128; or. 3) The enrollee does not provide the first month’s premium required to effectuate an enrollment by the due dates set forth at COMAR 14.35.07.11F.B. To request cancellation of the individual’s enr
14.35.14.09.htm 14.35.14.09. 09 Reinstatement.. A. An individual’s enrollment shall be reinstated:. 1) If applicable, under QHP provisions required by COMAR 31.10.25.04;. 2) If the Exchange determines an error was made by the Exchange that led to an improper termination or cancellation;3) If the carrier determines an error was made by the carrier that led to an improper termination or cancellation; or4) If the Exchange is ordered to reinstate the enrollee by the Maryland Insurance Administration, Of
14.35.14.10.htm 14.35.14.10. 10 Sanctions.. A carrier that fails to follow the requirements of this chapter may:. A. Be denied certification as an authorized carrier;. B. Be denied certification for a QHP offered for sale by the carrier on the Individual Exchange;. C. Have the carrier’s certification suspended or revoked;. D. Have the certification for a QHP offered for sale by the carrier on the Exchange suspended or revoked; orE. Be subject to other penalties under Insurance Article, §31-115(k) Annota
14.35.14.9999.htm 14.35.14.9999. Administrative History Effective date: June 8, 2015 (42:11 Md. R. 726) ―. Regulations .01―07 repealed and new Regulations .01―10 adopted effective March 11, 2019 (46:5 Md. R. 308)
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