Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 4 › Subtitle 25 - MARYLAND HEALTH CARE COMMISSION › Chapter 10.25.01 - Small Employer Health Benefits Plan Premium Subsidy Program › Section 10.25.01.02 - 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) "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
(b) The eligible owner's
				  adjusted gross income.
(3) "Carrier" has the meaning stated in
				  Insurance Article, §
											15-1201(c),
				  Annotated Code of Maryland.
(4)
				  "COMAR" means the Code of Maryland Regulations.
(5) "Commission" means the Maryland Health
				  Care Commission.
(6) "Commission
				  registry" means a web-based utility by which employers and employees are
				  enrolled in the Premium Subsidy Program.
(7) "Commission's official website" means
				  http://mhcc.maryland.gov/.
(8)
				  "Designated financial institution" means one or more financial institutions
				  with whom the participating carrier has made arrangements for administration of
				  HSAs in conjunction with the participating carrier's HSA compatible health
				  benefit plan.
(9) "Eligible
				  employee" means an individual who:
(a) Works
				  on a full-time basis and has a normal workweek of at least 30 hours;
				  and
(b) Is either:
(i) An employee;
(ii) A partner of a partnership;
(iii) An eligible owner; or
(iv) An independent contractor who is
				  included as an employee under a health benefit plan.
(10) Eligible Owner.
(a) "Eligible owner" means:
(i) A person with a 20 percent or greater
				  financial interest in a small employer who works at least 30 hours per week for
				  that small employer; or
(ii) An
				  Executive Director of a nonprofit corporation that has been determined by the
				  Internal Revenue Service to be exempt from taxation under § 501(c)(3),
				  (4), or (6) of the Internal Revenue Code who works at least 30 hours per week
				  for that small employer.
(b) "Eligible owner" includes an eligible
				  owner's spouse who works at least 30 hours per week for the small
				  employer.
(11) "Eligible
				  owner's adjusted gross income" means an amount equal to the adjusted gross
				  income reported on the eligible owner's individual federal tax return or 50
				  percent of the adjusted gross income reported on the eligible owner's joint
				  federal tax return for the most recent year.
(12) "Eligible owner's countable wage" means
				  an amount published by the Commission used to calculate the average wage of a
				  small employer.
(13) "Employee
				  premium" means the amount of the premium that is paid by the employee for that
				  employee's selected type of coverage.
(14) "Employee premium subsidy" means, for a
				  given employee's selected type of coverage, the amount of the premium subsidy
				  that shall be passed through to the enrolled employee by the employer in the
				  form of reduced payroll deductions for the health benefit plan.
(15) "Employee's eligible HSA contribution"
				  means the lesser of:
(a) An amount published
				  by the Commission; or
(b) An
				  employee's contribution to an HSA, made through regular payroll deductions
				  deposited by the employer on behalf of the employee in the employee's HSA
				  established at the carrier's designated financial institution.
(16) Employee Wage.
(a) "Employee wage" means, for a given
				  eligible employee, the employee's estimated annual earnings at the time of
				  initial or renewal application for the Premium Subsidy Program, including any
				  salary, wages, commissions, bonuses, profit sharing, and reportable
				  tips.
(b) "Employee wage" includes,
				  for purposes of this program, income received from an employee's ownership
				  interest in the business.
(17) "Employer's eligible HSA contribution"
				  means an annual contribution to an employee's HSA:
(a) Established at the carrier's designated
				  financial institution;
(b) Made by
				  an employer according to a commitment made at enrollment or renewal;
(c) Equal for all employees choosing a given
				  HSA-compatible health benefit plan; and
(d) Contributed either in a single payment at
				  the beginning of the policy year or in equal installments throughout the policy
				  year.
(18) "Enrolled
				  employee" means an eligible employee approved by the Commission to receive the
				  premium subsidy.
(19) "Enrolled
				  employer" means a small employer approved by the Commission to receive the
				  premium subsidy.
(20) "Family" has
				  the meaning stated in COMAR
				  31.11.06.02B(19).
(21) Family Adjusted Gross Income.
(a) "Family adjusted gross income" means, for
				  an unmarried employee and for a married employee filing jointly, the adjusted
				  gross income reported on the employee's most recent federal tax
				  return.
(b) "Family adjusted gross
				  income", for a married employee filing separately, means the sum of the
				  adjusted gross income reported on the employee's most recent federal tax return
				  and the adjusted gross income reported on the most recent federal tax return of
				  the employee's spouse.
(22) "Health benefit plan" has the meaning
				  stated in Insurance Article, §
											15-1201(f),
				  Annotated Code of Maryland.
(23)
				  "Health insurance" has the meaning stated in Insurance Article, §
											1-101(p),
				  Annotated Code of Maryland.
(24)
				  "Health savings account (HSA)" means a health savings account as defined in the
				  Medicare Prescription Drug, Improvement and Modernization Act of 2003, Title
				  12, § 1201(a), as codified at Part VII, Subchapter B, Chapter 1,
				  §223(d) of the Internal Revenue Code.
(25) "Individual coverage" means a health
				  benefit plan that insures an individual employee only.
(26) "Initial application" means a subsidy
				  applicant's first application to receive the premium subsidy.
(27) "Licensed insurance producer" has the
				  meaning stated in Insurance Article, §
											1-101(w),
				  Annotated Code of Maryland.
(28)
				  "Maximum average wage for new applications" means an amount published by the
				  Commission that represents the maximum average annual wage at which an employer
				  not currently participating in the Premium Subsidy Program is eligible to apply
				  for participation.
(29) "Maximum
				  average wage for participants" means an amount published by the Commission that
				  represents the maximum average annual wage, calculated at time of renewal, at
				  which an enrolled employer may continue to participate in the Premium Subsidy
				  Program.
(30) "Maximum eligible
				  firm size" means a number published by the Commission that represents the
				  largest number of eligible employees a small business may have at the time of
				  policy renewal and still be eligible for participation in the Premium Subsidy
				  Program.
(31) "Maximum income for
				  other than individual coverage" means an amount published by the Commission
				  that represents the maximum family adjusted gross income at which an eligible
				  employee may receive a premium subsidy for other than individual
				  coverage.
(32) "Maximum subsidy
				  table" means a table published by the Commission that describes, for each type
				  of coverage and average wage of business, the maximum premium subsidy that may
				  be provided for each employee electing that type of coverage.
(32-1) "Minimum countable wage" means an amount published
					 by the Commission that represents the minimum annual wage for an eligible
					 employee that can be used to calculate the average wage of a small
					 employer.
(33) "Other than
				  individual coverage" means the following types of coverage:
(a) Individual plus children;
(b) Individual plus spouse; or
(c) Individual plus children and
				  spouse.
(34)
				  "Participating carrier" means a carrier who:
(a) Participates in the Maryland small group
				  market as defined under COMAR 31.11.06;
(b) Agrees to offer a qualifying health plan;
				  and
(c) Enters into a written
				  participation agreement with the Commission.
(35) "Policy" has the meaning stated in
				  Insurance Article, §
											1-101(ee),
				  Annotated Code of Maryland.
(36)
				  "Policy year" means a 365-day period that begins on the policy's effective date
				  or a period of 1 full calendar-year, under a health benefit plan providing
				  coverage to employers and their employees, as defined in the policy.
(37) "Premium" has the meaning stated in
				  Insurance Article, §
											1-101(ff),
				  Annotated Code of Maryland, applied to a given employee's selected type of
				  coverage.
(38) "Premium subsidy"
				  means the amount paid to the participating carrier by the State in order to
				  reduce the premium paid by the enrolled employer for a given eligible
				  employee's selected type of coverage.
(39) "Premium Subsidy Program" means the
				  Small Employer Health Benefit Plan Premium Subsidy Program, as defined in
				  Insurance Article, § 15-12 A-02, Annotated Code of Maryland.
(40) "Prominent carrier" means a carrier that
				  insures at least 10 percent of the total lives insured in the small group
				  market.
(41) "Qualifying health
				  plan" means a Comprehensive Standard Health Benefit Plan, as defined under
				  COMAR 31.11.06, together with riders, that includes a wellness benefit defined
				  in Insurance Article, §
											15-1201(s),
				  Annotated Code of Maryland.
(42)
				  "Quarterly wage reports" means the reporting of wages on quarterly employment
				  reports as described in COMAR
				  09.32.01.14B.
(43) "Renewal application" means
				  an application designated by the Commission for applying for renewal of the
				  premium subsidy.
(44) "Section 125
				  Payroll Deduction Plan" means a payroll deduction plan pursuant to §125 of
				  the Internal Revenue Code.
(45)
				  "Size factor" means a factor published by the Commission, based on the number
				  of eligible employees of a small employer at the time of policy renewal, and
				  used to calculate the premium subsidy.
(46) "Small employer" has the meaning stated
				  in Insurance Article, §
											15-1201, Annotated Code of
				  Maryland.
(47) "Subsidy
				  administrator" means one or more entities:
(a) Designated by the participating carrier
				  to administer enrollment, registration, billing, accounting, or reconciliation
				  on behalf of the participating carrier; and
(b) That is either a component of the carrier
				  organization, or a separate entity under contract with the participating
				  carrier that is bonded and subject to audit by the participating carrier and
				  the Commission.
(48)
				  "Subsidy applicant" means either an employer or employee applying to receive
				  the premium subsidy.
(49) "Subsidy
				  application" means an application designated by the Commission to be completed,
				  signed, and submitted in order for the Commission to determine eligibility for
				  the Premium Subsidy Program.
(50)
				  "Subsidy program cap" means a dollar amount published by the Commission that
				  represents the Commission's estimate of the total annualized subsidy payment
				  that is sustainable.
(51) "Total
				  premium" means the sum of all premiums for coverage under the employer's health
				  benefit plan.
(52) "Total premium
				  subsidy" means the sum of all premium subsidies for coverage under the
				  employer's health benefit plan.
(53) "Type of coverage" means the choice of
				  coverage for each eligible employee's health benefit plan, specifically:
(a) Individual only;
(b) Individual plus children;
(c) Individual plus spouse; or
(d) Individual plus children and
				  spouse.
(54) "Wellness
				  benefit" has the meaning stated in Insurance Article, §
											15-201, Annotated Code of
				  Maryland.
(55) "Written
				  participation agreement" means a contract between a participating carrier and
				  the Commission that defines:
(a) The terms and
				  conditions of the participating carrier's involvement in the Premium Subsidy
				  Program; and
(b) The roles and
				  responsibilities of the subsidy administrator in administering the Premium
				  Subsidy Program.