reglab/statecodes huggingface dataset:
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 35 - MARYLAND HEALTH BENEFIT EXCHANGE › Chapter 14.35.11 - Fair Hearings of Individual Exchange Eligibility Determinations › Section 14.35.11.14 - Authorized Representatives

Current through Register Vol. 51, No. 14, July 12, 2024
A.
				Definitions.
(1) "Authorized representative"
				means an individual or organization acting responsibly on behalf of the
				applicant in accordance with this regulation, in assisting with an applicant's
				application, renewal of eligibility, appeals, and other ongoing communications
				with the Exchange.
(2) "Signature"
				includes electronic, including telephonically recorded, signatures and
				handwritten signatures transmitted by facsimile or other electronic
				transmissions.
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 35 - MARYLAND HEALTH BENEFIT EXCHANGE › Chapter 14.35.12 - Application Counselor Sponsoring Entity Designation Standards › Section 14.35.12.01 - Scope

Current through Register Vol. 51, No. 14, July 12, 2024
In General. This chapter applies to any community-based
				  organization, health care provider, unit of State or local government, or other
				  entity seeking designation as an application counselor sponsoring entity by the
				  Maryland Health Benefit Exchange.
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 35 - MARYLAND HEALTH BENEFIT EXCHANGE › Chapter 14.35.12 - Application Counselor Sponsoring Entity Designation Standards › Section 14.35.12.02 - Definitions

Current through Register Vol. 51, No. 14, July 12, 2024
A. In this
				subtitle, the following terms have the meanings indicated.
B. Terms Defined.
(1) "Applicant" means a community-based
				organization, health care provider, unit of State or local government, or other
				entity applying for designation as an application counselor sponsoring
				entity.
(2) 'Application counselor
				sponsoring entity" or "sponsoring entity" has the meaning set forth in
				Insurance Article, §
										31-101(a-2),
				Annotated Code of Maryland.
(3)
				"Certified application counselor" has the meaning set forth in Insurance
				Article, §
										31-101(a-1),
				Annotated Code of Maryland.
(4)
				"Commissioner" means the Maryland Insurance Commissioner.
(5) "Consolidated Services Center" has the
				meaning set forth in Insurance Article, §
										31-101(c-2),
				Annotated Code of Maryland.
(6)
				"Individual Exchange " or "Exchange " has the meaning set forth in Insurance
				Article, §
										31-101(h),
				Annotated Code of Maryland.
(7)
				"Individual Exchange connector entity" has the meaning set forth in Insurance
				Article, §
										31-101(k),
				Annotated Code of Maryland.
(8)
				"Individual Exchange navigator" has the meaning set forth in Insurance Article,
				§
										31-101(i),
				Annotated Code of Maryland.
(9)
				"Maryland Health Benefit Exchange " has the meaning set forth in Insurance
				Article, §
										31-101(e),
				Annotated Code of Maryland.
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 35 - MARYLAND HEALTH BENEFIT EXCHANGE › Chapter 14.35.12 - Application Counselor Sponsoring Entity Designation Standards › Section 14.35.12.03 - Eligibility Requirements

Current through Register Vol. 51, No. 14, July 12, 2024
To be eligible for designation as an application counselor
				  sponsoring entity, an applicant shall:
A. Complete and submit to the Maryland Health
				Benefit Exchange the application counselor sponsoring entity application set
				forth under Regulation .05 of this chapter;
B. Agree to comply with the requirements set
				forth in the application counselor sponsoring entity application, including the
				requirements for oversight of its certified application counselors;
C. Comply with any applicable requirements of
				the Department of Health and Mental Hygiene and the Commissioner; and
D. Enter into a formal written agreement with
				all employed or engaged certified application counselors whereby certified
				application counselors agree to comply with the provisions of the application
				counselor training and certification standards under COMAR 14.35.13 and
				45 CFR §
										155.225.
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 35 - MARYLAND HEALTH BENEFIT EXCHANGE › Chapter 14.35.12 - Application Counselor Sponsoring Entity Designation Standards › Section 14.35.12.04 - Scope of Authority

Current through Register Vol. 51, No. 14, July 12, 2024
A. A
				designated application counselor sponsoring entity may employ or engage
				certified application counselors to:
(1)
				Provide information to consumers about the full range of qualified health plan
				and qualified dental plan options and insurance affordability programs,
				including advance premium tax credits and cost-sharing subsidies, the Maryland
				Medical Assistance Program, and the Maryland Children's Health Program, for
				which they are eligible;
(2) Assist
				consumers with the application process for determining eligibility for
				insurance affordability programs, including advance premium tax credits and
				cost-sharing subsidies, the Maryland Medical Assistance Program, and the
				Maryland Children's Health Program;
(3) Facilitate plan selection and enrollment
				of eligible individuals in qualified health plans, qualified dental plans, and
				access to advance premium tax credit and other cost-sharing subsidies;
				and
(4) Provide to consumers
				uniform, factual, and unbiased information approved by the Maryland Medical
				Assistance Program about all participating managed care organizations,
				including report cards, lists of enhanced benefits and covered services, and
				participating providers.
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 35 - MARYLAND HEALTH BENEFIT EXCHANGE › Chapter 14.35.12 - Application Counselor Sponsoring Entity Designation Standards › Section 14.35.12.06 - Designation Term and Renewal

Current through Register Vol. 51, No. 14, July 12, 2024
A.
				Term. An application counselor sponsoring entity designation expires 2 years
				after the date it is issued unless it is renewed or revoked prior to that
				time.
B. Renewal.
(1) Notice.
(a) At least 60 days before the expiration of
				an application counselor sponsoring entity designation, the Maryland Health
				Benefit Exchange shall notify the application counselor sponsoring entity
				directly at the entity's address on file, including email address, with the
				Maryland Health Benefit Exchange, of the expiration date of an application
				counselor sponsoring entity designation.
(b) The notification shall include:
(i) A renewal application;
(ii) The date by which the Maryland Health
				Benefit Exchange must receive the renewal application for the renewal to be
				issued before the designation expires; and
(iii) The amount of any renewal
				fee.
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 35 - MARYLAND HEALTH BENEFIT EXCHANGE › Chapter 14.35.12 - Application Counselor Sponsoring Entity Designation Standards › Section 14.35.12.07 - Revocation of Designation

Current through Register Vol. 51, No. 14, July 12, 2024
The Maryland Health Benefit Exchange, in consultation with
				  the Commissioner and Maryland Department of Health, shall revoke an application
				  counselor sponsoring entity designation for any failure to act in accordance
				  with the application counselor sponsoring entity attestations set forth under
				  Regulation .05A of this chapter pursuant to the procedures for withdrawal or
				  revocation set forth under the agreement between the Maryland Health Benefit
				  Exchange and the application counselor sponsoring entity.
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 35 - MARYLAND HEALTH BENEFIT EXCHANGE › Chapter 14.35.13 - Application Counselor Training and Certification Standards › Section 14.35.13.01 - Scope

Current through Register Vol. 51, No. 14, July 12, 2024
This chapter sets forth the qualifications, training, and
				  certification standards for an agent, employee, or volunteer of an application
				  counselor sponsoring entity who applies to receive an application counselor
				  certification and is required under Insurance Article, §
									31-113(r)(1)(ii),
				  Annotated Code of Maryland, to hold an application counselor certification to
				  provide the services set forth below.
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 35 - MARYLAND HEALTH BENEFIT EXCHANGE › Chapter 14.35.13 - Application Counselor Training and Certification Standards › Section 14.35.13.02 - Definitions

Current through Register Vol. 51, No. 14, July 12, 2024
A. In this
				subtitle, the following terms have the meanings indicated.
B. Terms Defined.
(1) "Applicant" means a community-based
				organization, health care provider, unit of State or local government, or other
				entity applying for designation as an application counselor sponsoring
				entity.
(2) "Application counselor
				sponsoring entity" or "sponsoring entity" has the meaning set forth in
				Insurance Article, §
										31-101(a-2),
				Annotated Code of Maryland.
(3)
				"Certified application counselor" has the meaning set forth in Insurance
				Article, §
										31-101(a-1),
				Annotated Code of Maryland.
(4)
				"Commissioner" means the Maryland Insurance Commissioner.
(5) "Consolidated Services Center" has the
				meaning set forth in Insurance Article, §
										31-101(c-2),
				Annotated Code of Maryland.
(6)
				"Individual Exchange connector entity" has the meaning set forth in Insurance
				Article, §
										31-101(k),
				Annotated Code of Maryland.
(7)
				"Individual Exchange navigator" has the meaning set forth in Insurance Article,
				§
										31-101(i),
				Annotated Code of Maryland.
(8)
				"Insurance affordability programs" has the meaning set forth in
				42 CFR §
											435.4.
(9) "Maryland Health Benefit Exchange" has
				the meaning set forth in Insurance Article, §
										31-101(e),
				Annotated Code of Maryland.
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 35 - MARYLAND HEALTH BENEFIT EXCHANGE › Chapter 14.35.13 - Application Counselor Training and Certification Standards › Section 14.35.13.03 - Eligibility Requirements

Current through Register Vol. 51, No. 14, July 12, 2024
To qualify for an application counselor certification, an
				  applicant shall:
A. Be of good
				character and trustworthy;
B. Be at
				least 18 years old;
C. Be an agent,
				employee, or volunteer of an application counselor sponsoring entity;
D. Not be an Individual Exchange
				navigator;
E. Enter into a formal
				written agreement with an application counselor sponsoring entity agreeing to
				comply with the provisions of this chapter and
				45 CFR §
										155.225;
F. Successfully complete and comply with any
				ongoing requirements of the training program set forth under Regulation .06 of
				this chapter;
G. Complete and
				submit to the Maryland Health Benefit Exchange an application counselor
				application set forth under Regulation .05 of this chapter;
H. Agree to comply with the requirements set
				forth in the application counselor application; and
I. Comply with any applicable requirements of
				the Department of Health and Mental Hygiene and the
				Commissioner.
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 35 - MARYLAND HEALTH BENEFIT EXCHANGE › Chapter 14.35.13 - Application Counselor Training and Certification Standards › Section 14.35.13.04 - Scope of Authority

Current through Register Vol. 51, No. 14, July 12, 2024
A. A
				certified application counselor may:
(1)
				Provide information to consumers about the full range of qualified health plan
				and qualified dental plan options and insurance affordability programs,
				including advance premium tax credits and cost-sharing subsidies, the Maryland
				Medical Assistance Program, and the Maryland Children's Health Program, for
				which they are eligible;
(2) Assist
				consumers with the application process for determining eligibility for
				insurance affordability programs, including advance premium tax credits and
				cost-sharing subsidies, the Maryland Medical Assistance Program, and the
				Maryland Children's Health Program;
(3) Facilitate plan selection and enrollment
				of eligible individuals in qualified health plans, qualified dental plans, and
				access to advance premium tax credit and other cost-sharing subsidies;
				and
(4) Provide to consumers
				uniform, factual, and unbiased information approved by the Maryland Medical
				Assistance Program about all participating managed care organizations,
				including report cards, lists of enhanced benefits and covered services, and
				participating providers.
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 35 - MARYLAND HEALTH BENEFIT EXCHANGE › Chapter 14.35.13 - Application Counselor Training and Certification Standards › Section 14.35.13.06 - Training Requirements

Current through Register Vol. 51, No. 14, July 12, 2024
In order to obtain application counselor certification, an
				  individual shall:
A. Complete the
				training program specified under COMAR
				14.35.02.04A;
				and
B. Pass the examination
				specified under COMAR
				14.35.02.04D.
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 35 - MARYLAND HEALTH BENEFIT EXCHANGE › Chapter 14.35.13 - Application Counselor Training and Certification Standards › Section 14.35.13.07 - Term

Current through Register Vol. 51, No. 14, July 12, 2024
An application counselor certification expires 2 years after
				  the date it is issued unless it is renewed.
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 35 - MARYLAND HEALTH BENEFIT EXCHANGE › Chapter 14.35.13 - Application Counselor Training and Certification Standards › Section 14.35.13.08 - Renewal

Current through Register Vol. 51, No. 14, July 12, 2024
A. Notice.
(1) At least 60 days before the expiration of
				an application counselor certification, the Maryland Health Benefit Exchange
				shall notify the application counselor using the address on file, including
				email address, with the Maryland Health Benefit Exchange, of the expiration
				date of an application counselor certification.
(2) The notification shall include:
(a) A renewal application;
(b) The date by which the Maryland Health
				Benefit Exchange must receive the renewal application for the renewal to be
				issued before the certification expires; and
(c) The amount of any renewal
				fee.
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 35 - MARYLAND HEALTH BENEFIT EXCHANGE › Chapter 14.35.13 - Application Counselor Training and Certification Standards › Section 14.35.13.09 - Suspension or Revocation

Current through Register Vol. 51, No. 14, July 12, 2024
A. The
				Commissioner may suspend or revoke an application counselor certification for
				any reason set forth under Insurance Article, §
									31-113(l)(1),
				Annotated Code of Maryland, made applicable to application counselors pursuant
				to Insurance Article, §
									31-113(r),
				Annotated Code of Maryland, or for any reason set forth under
				45 CFR §
										155.225.
B. An application counselor's certification
				is automatically suspended if his or her application counselor sponsoring
				entity's designation expires or is withdrawn by the Maryland Health Benefit
				Exchange.
C. An application
				counselor's certification that has been suspended under §B of this
				regulation may be reinstated if the application counselor becomes an agent,
				employee, or volunteer of another application counselor sponsoring entity with
				a valid designation and executes the agreement required under Regulation
				.03A(5) of this chapter.
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 35 - MARYLAND HEALTH BENEFIT EXCHANGE › Chapter 14.35.14 - Termination, Cancellation, and Rescission of Qualified Health Plan › Section 14.35.14.01 - Scope

Current through Register Vol. 51, No. 14, July 12, 2024
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.
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 35 - MARYLAND HEALTH BENEFIT EXCHANGE › Chapter 14.35.14 - Termination, Cancellation, and Rescission of Qualified Health Plan › Section 14.35.14.02 - Definitions

Current through Register Vol. 51, No. 14, July 12, 2024
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 erroneous termination or cancellation
				action that results in restoration of an enrollment with no break in
				coverage.
(4) "Same QHP policy"
				means that one enrollee is enrolled under the same QHP contract as another
				enrollee.
(5) "Termination" means
				an action taken after a coverage effective date that ends an enrollee's
				enrollment through the Exchange for a date after the original coverage
				effective date resulting in a period during which the individual was enrolled
				in coverage through the Exchange.
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 35 - MARYLAND HEALTH BENEFIT EXCHANGE › Chapter 14.35.14 - Termination, Cancellation, and Rescission of Qualified Health Plan › Section 14.35.14.03 - Terminations in General

Current through Register Vol. 51, No. 14, July 12, 2024
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
				contract holder of a QHP to terminate coverage under Regulation .04 of this
				chapter for all enrollees promptly and without undue delay.
D. A carrier shall process the Exchange's
				termination determination under Regulation . 06 of this chapter promptly and
				without undue delay.
E. A carrier
				shall maintain records of termination of enrollment in a QHP in the format
				specified by the Exchange in an electronic data interchange format for a period
				of 10 years.
F. A carrier shall
				make reasonable accommodations for all individuals with disabilities (as
				defined by the Americans with Disabilities Act), including head-of-household
				and non-head-of-household enrollees, before terminating the individual's'
				enrollment.
G. A carrier shall send
				an electronic transaction to the Exchange documenting, or acknowledging, each
				termination of coverage carried out under this chapter, promptly and without
				undue delay.
H. In cases of
				retroactive termination dates, the carrier shall accept the Exchange's adjusted
				calculations ofAPTC, and premiums and changes to the plan variation of the
				QHP.
I. A carrier shall confirm the
				termination of an enrollee's coverage with a notice provided to the contract
				holder indicating the enrollees affected by the termination and the effective
				date of the termination.
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 35 - MARYLAND HEALTH BENEFIT EXCHANGE › Chapter 14.35.14 - Termination, Cancellation, and Rescission of Qualified Health Plan › Section 14.35.14.04 - Enrollee-Initiated Terminations-In General

Current through Register Vol. 51, No. 14, July 12, 2024
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
(2) Enrollees seeking to
				terminate coverage for the enrollee's household may notify either the Exchange
				or the QHP carrier.
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 35 - MARYLAND HEALTH BENEFIT EXCHANGE › Chapter 14.35.14 - Termination, Cancellation, and Rescission of Qualified Health Plan › Section 14.35.14.05 - Enrollee-Initiated Terminations-Due to Error, Misconduct, or Enrollment without Knowledge or Consent

Current through Register Vol. 51, No. 14, July 12, 2024
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.
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 35 - MARYLAND HEALTH BENEFIT EXCHANGE › Chapter 14.35.14 - Termination, Cancellation, and Rescission of Qualified Health Plan › Section 14.35.14.06 - Termination by the Exchange

Current through Register Vol. 51, No. 14, July 12, 2024
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).
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 35 - MARYLAND HEALTH BENEFIT EXCHANGE › Chapter 14.35.14 - Termination, Cancellation, and Rescission of Qualified Health Plan › Section 14.35.14.07 - Termination by Carrier

Current through Register Vol. 51, No. 14, July 12, 2024
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;
(4) If the carrier ceases to offer the QHP
				that an enrollee is enrolled in through the Exchange under
				45 CFR §
											147.106(b)(4) and the
				carrier follows the requirements under
				45 CFR §
											147.106(c);
(5) If the carrier ceases to offer any QHPs
				through the Exchange under 45 CFR §
											147.106(b)(4) and the
				carrier follows the requirements under
				45 CFR §
											147.106(d);
(6) If the enrollee has performed an act or
				practice that constitutes fraud or intentional misrepresentation of material
				fact in connection with the coverage under
				45 CFR §
											147.106(b)(2); or
(7) For nonpayment of premiums as specified
				in §B of this regulation.
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 35 - MARYLAND HEALTH BENEFIT EXCHANGE › Chapter 14.35.14 - Termination, Cancellation, and Rescission of Qualified Health Plan › Section 14.35.14.08 - Cancellation

Current through Register Vol. 51, No. 14, July 12, 2024
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.
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 35 - MARYLAND HEALTH BENEFIT EXCHANGE › Chapter 14.35.14 - Termination, Cancellation, and Rescission of Qualified Health Plan › Section 14.35.14.09 - Reinstatement

Current through Register Vol. 51, No. 14, July 12, 2024
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; or
(4) If the
				Exchange is ordered to reinstate the enrollee by the Maryland Insurance
				Administration, Office of Administrative Hearings, or a State or federal
				court.
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 35 - MARYLAND HEALTH BENEFIT EXCHANGE › Chapter 14.35.14 - Termination, Cancellation, and Rescission of Qualified Health Plan › Section 14.35.14.10 - Sanctions

Current through Register Vol. 51, No. 14, July 12, 2024
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; or
E. Be
				subject to other penalties under Insurance Article, §
									31-115(k),
				Annotated Code of Maryland, and COMAR 14.35.16.11.
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 35 - MARYLAND HEALTH BENEFIT EXCHANGE › Chapter 14.35.15 - Carrier Certification Standards › Section 14.35.15.01 - Scope

Current through Register Vol. 51, No. 14, July 12, 2024
This chapter describes the standards a carrier shall meet to
				  be certified as a carrier authorized to participate on the Maryland Health
				  Benefit Exchange under Insurance Article, §
									31-115(b)(5),
				  Annotated Code of Maryland, in the Individual and SHOP Exchanges. This chapter
				  does not apply to certification of Individual or SHOP Exchange qualified
				  plans.
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 35 - MARYLAND HEALTH BENEFIT EXCHANGE › Chapter 14.35.15 - Carrier Certification Standards › Section 14.35.15.02 - Definitions

Current through Register Vol. 51, No. 14, July 12, 2024
A. In this chapter,
				the following terms have the meanings indicated.
B. Terms Defined.
(1) 'Active carrier business agreement" means
				the most recent version of the carrier business agreement provided by the
				Exchange, signed by the Exchange and the carrier, and on file with the
				Exchange.
(2) "Active non-exchange
				entity agreement" means the most recent version of the non-exchange entity
				agreement provided by the Exchange, signed by the Exchange and the carrier, and
				on file with the Exchange.
(3)
				"Authorized carrier" means a carrier that holds a current certification of
				authorization issued by the Exchange as set forth in Regulation .03 of this
				chapter.
(4) "Carrier business
				agreement" means the agreement between the Exchange and the carrier that
				contains terms and conditions governing compliance with the Annotated Code of
				Maryland, Exchange policies, and State and federal regulations.
(5) "Carrier reference manual" means the
				document developed by the Exchange that provides business rules and operational
				instructions to authorized carriers participating on the Exchange.
(6) "Health maintenance organization (HMO)"
				has the meaning stated in Health-General Article, § 19-701(g), Annotated
				Code of Maryland.
(7) "Member"
				means a qualified individual or qualified employee enrolled in a QHP with a
				particular authorized carrier through the Exchange.
(8) Member Level Report.
(a) "Member level report" means a report of
				the carrier's QHP member enrollment files with the Exchange at a specified
				time.
(b) "Member level report"
				includes:
(i) Information demonstrating the
				member enrolled through the Exchange;
(ii) The coverage effective date;
(iii) The coverage termination date, if
				applicable;
(iv) The termination
				reason, if applicable;
(v) The
				premium amount; and
(vi) The amount
				of advanced premium tax credits, if applicable.
(9) "Metal level" means a QHP at the bronze,
				silver, gold, or platinum coverage level.
(10) "Non-exchange entity agreement" means
				the agreement between the Exchange and the carrier that contains privacy and
				security provisions.
(11) "SERFF
				binder" means the portfolio of information that State laws and regulations
				require carriers to submit to the Exchange through SERFF.
(12) "System companion guide" means the
				document developed by the Exchange that provides instructions to authorized
				carriers to process enrollment information through electronic data transactions
				between the Exchange and the carrier.
(13) "System for Electronic Rate and Form
				Filing (SERFF) " means the online system the Exchange and the Administration
				use to accept, review, and approve carrier product and rate filings.
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 35 - MARYLAND HEALTH BENEFIT EXCHANGE › Chapter 14.35.15 - Carrier Certification Standards › Section 14.35.15.03 - Carrier Conditions for Participation and Certification- Generally

Current through Register Vol. 51, No. 14, July 12, 2024
A. In order to
				participate in the Exchanges, carriers must hold a current certificate of
				authorization issued by the Exchange.
B. To receive a certificate of authorization
				from the Exchange, carriers shall:
(1)
				Possess a certificate of authority to:
(a)
				Act as an insurer and engage in the business of health insurance under
				Insurance Article, Title 4, Subtitle 1, Annotated Code of Maryland;
(b) Operate a health maintenance organization
				under Health-General Article, § 19-707 ', Annotated Code of
				Maryland;
(c) Operate as a dental
				plan organization under Insurance Article, Title 14, Subtitle 4, Annotated Code
				of Maryland; or
(d) Operate as a
				nonprofit health service plan under Insurance Article, 14 - 108, Annotated Code
				of Maryland;
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 35 - MARYLAND HEALTH BENEFIT EXCHANGE › Chapter 14.35.15 - Carrier Certification Standards › Section 14.35.15.04 - Application for Authorization

Current through Register Vol. 51, No. 14, July 12, 2024
A.
				Carriers shall submit an application to the Exchange each year, in the form
				specified by the Exchange, no later than the first business day of July of the
				year before the certification is effective.
B. An application will not be deemed complete
				until a carrier submits all of the required application elements under §A
				of this regulation.
C. The
				Exchange, within 45 days of receipt of a completed application, shall notify a
				carrier of the decision to approve or deny the application.
D. If the Exchange does not provide a carrier
				notice of a decision to approve or deny a carrier's application within 45 days
				of application submission, then the carrier may appeal to MHBE Board of
				Trustees through a written letter to request an expedited decision within 14
				days of the appeal.
E. An
				application subject to an expedited decision under §D of this regulation
				shall be deemed denied by the Exchange if the appeal is not ruled upon by the
				Board within 14 days.
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 35 - MARYLAND HEALTH BENEFIT EXCHANGE › Chapter 14.35.15 - Carrier Certification Standards › Section 14.35.15.05 - Conditions for Participation - Authorized Carrier Conduct

Current through Register Vol. 51, No. 14, July 12, 2024
A. An
				authorized carrier may not discriminate on the basis of race, color, national
				origin, disability, age, sex, gender identity, or sexual orientation in the
				administration of a qualified plan.
B. An authorized carrier shall offer
				insurance producer compensation for qualified plans offered through the
				Exchange equal to insurance producer compensation for qualified plans offered
				outside of the Exchange.
C. An
				authorized carrier shall comply with any applicable State laws and regulations
				regarding marketing by carriers, including:
(1) Any fair marketing standards developed
				jointly by the Exchange and the Commissioner under Insurance Article, §
										31-115(k)(2)(x),
				Annotated Code of Maryland;
(2)
				Insurance Article, §§
										27-202 - 27-205, Annotated
				Code of Maryland, for insurers, nonprofit health service plans, and dental plan
				organizations; and
(3)
				Health-General Article, §19-729, Annotated Code of Maryland, for health
				maintenance organizations.
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 35 - MARYLAND HEALTH BENEFIT EXCHANGE › Chapter 14.35.15 - Carrier Certification Standards › Section 14.35.15.06 - Conditions for Participation - Individual Exchange Premium Payment

Current through Register Vol. 51, No. 14, July 12, 2024
A. An
				authorized carrier shall follow the premium payment procedures and deadlines
				under COMAR
				14.35.07.11F.
B. An authorized carrier may
				establish a premium payment threshold policy under COMAR
				14.35.07.11G
C. An authorized carrier may not
				use a payment made to effectuate coverage under COMAR
				14.35.07.11F(1)
				to pay outstanding balances attributed to previously terminated coverage of the
				qualified individual.
D. An
				authorized carrier in the Individual Exchange shall calculate that the premium
				for coverage lasting less than 1 month equals the product of:
(1) The premium for 1 month of coverage
				divided by the number of days in the month; and
(2) The number of days for which coverage is
				being provided in the month.
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 35 - MARYLAND HEALTH BENEFIT EXCHANGE › Chapter 14.35.15 - Carrier Certification Standards › Section 14.35.15.07 - Conditions for Participation-Individual Exchange Carrier Notice Requirements

Current through Register Vol. 51, No. 14, July 12, 2024
A. An
				authorized carrier shall provide enrollees newly effectuating coverage an
				enrollment information package that is written in plain language and in a
				manner that is accessible to individuals living with disabilities and
				individuals who have limited English proficiency.
B. If an enrollee is delinquent on premium
				payment, the carrier shall provide the enrollee with notice of such payment
				delinquency.
C. If an authorized
				carrier terminates an enrollee's coverage or enrollment in a qualified plan
				through the Exchange in accordance with COMAR 14.35.14 and
				45 CFR §
										155.430(b)(2)(i), (ii), or
				(Hi), the authorized carrier shall, promptly
				and without undue delay provide the enrollee with a notice of termination that
				includes:
(1) The termination effective date;
				and
(2) The reason for
				termination.
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 35 - MARYLAND HEALTH BENEFIT EXCHANGE › Chapter 14.35.15 - Carrier Certification Standards › Section 14.35.15.08 - Requirements for Qualified Plans

Current through Register Vol. 51, No. 14, July 12, 2024
A. The
				authorized carrier shall offer in the Exchange only plans that the Exchange
				certifies as qualified plans under COMAR 14.35.16.
B. The authorized carrier shall ensure that
				each of its plans comply with the plan certification requirements in COMAR
				14.35.16 on an ongoing basis.
C. An
				authorized carrier shall offer no more than:
(1) Four benefit designs per metal level in
				the Individual Exchange and four benefit designs per metal level in the SHOP
				Exchange in plan year 2024 and prior plan years; and
(2) Three benefit designs per metal level in
				the Individual Exchange and four benefit designs per metal level in the SHOP
				Exchange beginning in plan year 2025.
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 35 - MARYLAND HEALTH BENEFIT EXCHANGE › Chapter 14.35.15 - Carrier Certification Standards › Section 14.35.15.09 - Network Adequacy

Current through Register Vol. 51, No. 14, July 12, 2024
For each qualified plan that the authorized carrier seeks to
				  offer for sale through the Individual Exchange or the SHOP Exchange, the
				  authorized carrier shall:
A. Follow
				the Maryland Insurance Administration network adequacy and network reporting
				regulations set forth under COMAR 31.10.44 or COMAR 31.10.45;
B. Complete an attestation in the carrier
				application under Regulation . 04 of this chapter indicating carrier compliance
				with COMAR 31.10.44 or COMAR 31.10.45; and
C. Submit a document providing consumers with
				information on the carrier's network that is suitable for publishing in
				qualified plan shopping in the Individual Exchange in a form and manner
				detailed by the Individual Exchange.
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 35 - MARYLAND HEALTH BENEFIT EXCHANGE › Chapter 14.35.15 - Carrier Certification Standards › Section 14.35.15.10 - Waiver Authority

Current through Register Vol. 51, No. 14, July 12, 2024
A. The
				Exchange, with the approval of the Exchange Board of Trustees, and for reasons
				solely within the discretion of the Exchange, may grant a waiver to a specific
				provision of the application for certification, with or without
				conditions.
B. A waiver may only be
				granted to the extent it does not conflict with the provisions of Insurance
				Article, Annotated Code of Maryland, or applicable federal and State
				law.
C. A carrier may submit a
				request for a waiver on a form developed by the Exchange.
D. Carriers who are newly seeking
				accreditation from outside entities and have not yet received such
				accreditation by the Exchange's application deadline should use the waiver
				process to seek waiver or modification of this condition.
E. The request shall state:
(1) The provision from which a waiver is
				sought;
(2) The reason the carrier
				is unable to comply with the provision; and
(3) The reason that compliance with the
				provision will impose a substantial hardship.
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 35 - MARYLAND HEALTH BENEFIT EXCHANGE › Chapter 14.35.15 - Carrier Certification Standards › Section 14.35.15.11 - Authorization Renewals

Current through Register Vol. 51, No. 14, July 12, 2024
A. The
				Exchange shall review the performance of authorized carriers on an annual
				basis.
B. Authorized carriers shall
				submit information in a form and manner required by the Exchange about
				Exchange-specific complaints and grievances, upon request.
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 35 - MARYLAND HEALTH BENEFIT EXCHANGE › Chapter 14.35.16 - Plan Certification Standards › Section 14.35.16.01 - Scope

Current through Register Vol. 51, No. 14, July 12, 2024
This chapter describes the standards a qualified health plan
				  shall meet in order to be certified as a QHP by the Maryland Health Benefit
				  Exchange under Insurance Article, §
									31-115, Annotated Code of
				  Maryland This chapter addresses standards for QHP certification for both the
				  Individual and SHOP Exchanges, unless otherwise noted Standards for carrier
				  certification for the Exchange are addressed in COMAR 14.35.15. This chapter
				  does not address plan -certification standards for QDPs or QVPs.
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 35 - MARYLAND HEALTH BENEFIT EXCHANGE › Chapter 14.35.16 - Plan Certification Standards › Section 14.35.16.02 - Definitions

Current through Register Vol. 51, No. 14, July 12, 2024
A. In this chapter,
				the following terms have the meanings indicated.
B. Terms Defined.
(1) Annual Letter to Issuers.
(a) "Annual Letter to Issuers" means a
				written communication, issued by the Exchange, which should be interpreted in
				the same manner as the Annual Letter to Issuers that is distributed by the
				federally facilitated Exchange.
(b)
				"Annual Letter to Issuers " includes instruction on how issuers shall meet
				compliance with QHP certification standards, establishes timelines on
				implementation, details Exchange expectations of issuer compliance with such
				certification standards, and alerts issuers of policy developments.
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 35 - MARYLAND HEALTH BENEFIT EXCHANGE › Chapter 14.35.16 - Plan Certification Standards › Section 14.35.16.03 - Qualified Health Plan Certification-In General

Current through Register Vol. 51, No. 14, July 12, 2024
A. An authorized carrier shall apply for a
				certificate of authorization for each health benefit plan the carrier intends
				to offer on the Exchange.
B. The
				authorized carrier shall no longer offer a QHP on the Exchange, if:
(1) The plan's certification of authorization
				expires;
(2) The plan is
				decertified by the Exchange;
(3)
				The carrier elects to withdraw from the market with the Exchange, under
				45 CFR §
											156.290; or
(4) The carrier elects not to offer or renew
				the QHP on the Exchange in accordance with Insurance Article, Annotated Code of
				Maryland.
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 35 - MARYLAND HEALTH BENEFIT EXCHANGE › Chapter 14.35.16 - Plan Certification Standards › Section 14.35.16.04 - Qualified Health Plan Certification-Application

Current through Register Vol. 51, No. 14, July 12, 2024
A. Each authorized carrier shall annually
				submit an application, in a form specified by the Annual Letter to Issuers, for
				each health benefit plan intended to be certified as a QHP to be offered on the
				Exchange.
B. A carrier shall submit
				a completed application, including all required information and submissions
				under this regulation, to the Exchange.
C. The Exchange shall notify a carrier of the
				application status within 45 days of receipt of a completed
				application.
D. If an application
				is determined incomplete, the Exchange shall notify a carrier of the
				application status within 45 days of the initial submission.
E. Information Submission.
(1) An authorized carrier shall submit an
				initial submission containing the information required under §§E and
				F of this regulation and Regulations .04 - .10 of this chapter as part of the
				application under §B of this regulation and detailed through the Annual
				Letter to Issuers.
(2) If requested
				by the Exchange, an authorized carrier shall submit a supplement to its initial
				submission under §E(1) of this regulation.
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 35 - MARYLAND HEALTH BENEFIT EXCHANGE › Chapter 14.35.16 - Plan Certification Standards › Section 14.35.16.05 - Qualified Health Plan Certification-Plan Service Areas

Current through Register Vol. 51, No. 14, July 12, 2024
A. As part of a QHP certification
				application, an authorized carrier shall submit:
(1) A description of the boundaries of the
				service area of any health benefit plan that is smaller than the State of
				Maryland; and
(2) For any service
				area smaller than the State of Maryland, an explanation of the reason for the
				smaller service area, including a justification that the boundaries are not
				designed to discriminate against individuals excluded from the health benefit
				plan's service area.
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 35 - MARYLAND HEALTH BENEFIT EXCHANGE › Chapter 14.35.16 - Plan Certification Standards › Section 14.35.16.06 - Qualified Health Plan Certification-Provider Directories Specific to Individual Exchange

Current through Register Vol. 51, No. 14, July 12, 2024
A. An
				authorized carrier shall submit to the Individual Exchange the health benefit
				plan's provider directory information for each QHP's network.
B. Provider directory data shall include the
				requirements specified in Insurance Article, §
									15-112(n)(3),
				Annotated Code of Maryland, as well as be current, accurate, and
				complete.
C. Provider directory
				data may include:
(1) Program and community
				health center names;
(2) Providers'
				affiliations with certain facilities, programs, and centers; and
(3) Any other information that may assist
				consumers in searching for specific programs or centers by name.
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 35 - MARYLAND HEALTH BENEFIT EXCHANGE › Chapter 14.35.16 - Plan Certification Standards › Section 14.35.16.07 - Qualified Health Plan Certification - Essential Community Providers

Current through Register Vol. 51, No. 14, July 12, 2024
A. For each
				health benefit plan that a carrier seeks to offer through the Exchange, the
				carrier shall make all good faith efforts to contract with at least 35 percent
				of available essential community providers in the plan's service area as part
				of each plan's provider network, except as specified in §C of this
				regulation.
B. Additional Essential
				Community Providers.
(1) Included with its
				application for certification and in the form provided by the Exchange, the
				carrier may write in additional essential community providers that are not
				included in the definition for essential community provider under Regulation
				.02B of this chapter.
(2) If
				available, the carrier shall include the following information when writing in
				additional essential community health providers:
(a) The provider's zip code reflecting a
				provider location within a low-income zip code or Health Professional Shortage
				Areas included on the "low-Income and Health Professional Shortage Area Zip
				Code listing" from CMS;
(b) The
				provider's service street address, which may not be a Post Office Box number;
				and
(c) The National Provider
				Identifier (NPI) number, if the provider has such a number, or an alternate
				identification, such as a Tax Identification Number, if the provider does not
				have such a number.
(3)
				The authorized carrier shall provide information under this section as part of
				the application submitted under Regulation .04 of this chapter.