Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.41 - Employed Individuals with Disabilities › Section 10.09.41.07 - Premium

Current through Register Vol. 51, No. 14, July 12, 2024
A. Submission
				  of Premium.
(1) Unless an exception under
				  §A(2) of this regulation applies or a timely claim of hardship is raised
				  pursuant to §C of this regulation, an applicant or recipient shall, as a
				  condition of eligibility for the EID coverage group, pay the premium specified
				  in §A(3) of this regulation.
(2) Limitation of Premium Requirement.
(a) An applicant or recipient with income at
				  or below the federal poverty level is not required to pay a premium as a
				  condition of eligibility in the EID coverage group.
(b) With respect to an applicant determined
				  eligible subject to the requirements of §A(3) of this regulation, the
				  Department shall waive the premium payment before the notice of eligibility for
				  a period not to exceed 6 months if such notice of eligibility is delayed by
				  factors beyond the applicant's control.
(3) An applicant or participant whose
				  assistance unit has income:
(a) Above the
				  federal poverty level, but at or below 200 percent of the federal poverty
				  level, shall pay a monthly premium of $25;
(b) Above 200 percent, but at or below 250
				  percent of the federal poverty level, shall pay a monthly premium of $40;
(c) Above 250 percent, but at or
				  below 300 percent of the federal poverty level, shall pay a monthly premium of
				  $55;
(d) Above 300 percent, but at
				  or below 450 percent of the federal poverty level, shall pay a monthly premium
				  of 4 percent of the monthly net countable income determined under Regulation
				  .04B of this chapter;
(e) Above 450
				  percent, but at or below 600 percent of the federal poverty level, shall pay a
				  monthly premium of 5 percent of the monthly net countable income determined
				  under Regulation .04B of this chapter; or
(f) Above 600 percent of the federal poverty
				  level, shall pay a monthly premium of 7.5 percent of the monthly net countable
				  income determined under Regulation .04B of this chapter.
(4) Annual Premium Adjustment. Beginning
				  March 1, 2014, and as of March 1 of each year thereafter, the Department shall
				  recalculate the premium amounts set forth in §A(3) of this regulation and
				  adjust them to reflect the federal poverty level then in effect.
(5) An applicant or recipient to whom
				  §A(3) of this regulation applies shall, within 30 days of the Department's
				  request for payment pursuant to Regulation §A(4) of this regulation:
(a) Pay the full premium due as specified in
				  the request for payment issued pursuant to §A(4) of this regulation;
				  or
(b)
												§A(3)(b) of this
				  regulation, at 200 percent of the federal poverty level then in effect;
				  or
(c)
												§A(3)(c) of this
				  regulation, at 250 percent of the federal poverty level then in
				  effect.
(6) Request for
				  Payment. With respect to an applicant or recipient determined eligible subject
				  to the requirements of §A(3) of this regulation, the Department shall
				  issue a request for payment of the applicable premium, indicating that the
				  applicant or recipient shall pay the amount specified within 30 days of the
				  date the Department mailed the request for payment.
(7) An applicant or recipient to whom
				  §A(3) of this regulation applies shall, within 30 days of the Department's
				  request for payment pursuant to Regulation §A(6) of this regulation:
(a) Pay the full premium due as specified in
				  the request for payment issued pursuant to §A(6) of this regulation;
				  or
(b) Submit a claim of hardship
				  as authorized by §C of this regulation.
(8) Upon request by the recipient, the
				  Department shall approve an unemployment grace period, not to exceed 6 months
				  within a 12-month period, provided the recipient:
(a) Has unemployment due to medical reasons
				  or involuntary job loss;
(b) Is
				  otherwise eligible for EID; and
(c)
				  Continues to pay the premium during the unemployment grace period.