Code of Massachusetts Regulations › 956 CMR - COMMONWEALTH HEALTH INSURANCE CONNECTOR AUTHORITY › Title 956 CMR 12.00 - Eligibility, Enrollment, and Hearing Process for Connector Programs › Section 12.12 - Premiums, Delinquency, and Reinstatement

Current through Register 1525, July 5, 2024
(1)
Enrollee and Small Employer
			 Premiums
. Enrollees who are assessed a Premium and Small Employers
			 are responsible for monthly payments that must be paid on or before a due date
			 set by the Connector. The Connector will establish and maintain multiple
			 convenient payment methods for Enrollees and Small Employers. The Connector
			 will transmit Premium payments received from Enrollees or Small Employers to
			 the Health Plans in which they are enrolled.
(2)
Delinquent Enrollee Premiums
			 for Non-group Health Plans without Financial Assistance
. An
			 Enrollee in a Non-group Health Plan without Financial Assistance who fails to
			 pay a monthly Enrollee Premium in full by the payment due date will be
			 considered delinquent and will be notified when the account is past due. This
			 notice of delinquency will inform the Enrollee that, if payment of all
			 outstanding Premium is not received in full on or before the payment due date
			 indicated in the notice, then the coverage will be terminated retroactively to
			 the last day of the last month for which the Enrollee has paid for coverage in
			 full.
(3)
Termination
			 from a Non-group Health Plans without Financial Assistance for Failure to Pay
			 Enrollee Premiums
. If a delinquent Enrollee in a Non-group Health
			 Plan has not paid outstanding Premiums in full by the due date indicated in the
			 notice of delinquency, then the coverage is terminated retroactively to the
			 last day of the last month for which the Enrollee has paid for coverage in
			 full. The Connector shall notify the Enrollee of the termination.
(4)
Delinquent Enrollee Premiums
			 for Non-group Health Plans with Financial Assistance
. An Enrollee
			 in a Health Plan with APTC Only or in ConnectorCare who fails to pay a monthly
			 Premium in full by the payment due date will be considered delinquent and will
			 be notified when the account is past due. If an Enrollee's account is
			 delinquent for two consecutive months, the Enrollee will be notified by a
			 notice of delinquency which will inform the Enrollee that, if payment of all
			 outstanding Premium is not received in full on or before the payment due date
			 indicated in the notice, then the coverage will be terminated retroactively to
			 the last day of the first coverage month in which the Enrollee was
			 delinquent.
(5)
Termination from a Non-group Health Plan with Financial Assistance
			 for Failure to Pay Enrollee Premiums
. If an Enrollee who is
			 delinquent fails to pay all Premiums owed in full by the due date after
			 receiving the second notice described in 956 CMR 12.12(4), then the coverage is
			 terminated retroactively to the last day of the first coverage month in which
			 the Enrollee was delinquent. The Enrollee will be notified of the termination
			 with a notice of termination.
(6)
Reinstating Coverage in a Non-Group Health Plan Following
			 Termination for Failure to Pay Premiums
. An Enrollee in a
			 Non-Group Health Plan who was terminated for non-payment of Premium and who
			 makes a timely request to reinstate coverage may do so, provided that all
			 outstanding Premiums for such terminated Enrollee have been paid in full, as
			 well as the next month's Premium, by the deadline determined by the
			 Connector.
(7)
Waiver
			 or Reduction of Premium for Extreme Financial Hardship
.
(a) Extreme financial hardship means that the
			 individual has shown to the satisfaction of the Connector that the individual:
1. Is homeless, or is more than 30 days in
			 arrears in rent or mortgage payments, or has received an eviction or
			 foreclosure notice within the last 60 days; or
2. Has a shut-off notice, or has been shut
			 off, or has a refusal to deliver essential utilities within the 60 days prior
			 to application (gas, electric, oil, water, or sole telephone); or
3. Has incurred a significant, unexpected
			 increase in essential expenses within the last six months resulting directly
			 from the consequences of:
a. Domestic
			 violence;
b. The death of a spouse,
			 family member, or partner with primary responsibility for child care;
c. The sudden need to provide full-time care
			 for self, for an aging parent or for another family member, including a major,
			 extended illness of a child that requires a working parent to hire a full-time
			 caretaker for the child; or
d. A
			 fire, flood, natural disaster, or other unexpected natural or human-caused
			 event causing substantial household or personal damage for the individual;
			 or
4. Has filed for
			 bankruptcy within the last 12 months as long as the debts have not yet been
			 discharged.