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 12.11 - Enrollment in, Open Enrollment and Special Enrollment Periods Applicable to, and Termination from Small-group Health Plans

Current through Register 1525, July 5, 2024
(1)
Enrollment in Small-group
			 Health Plans
. Following a determination of eligibility, Eligible
			 Small Employers will be instructed to select a Small Group Health Plan for
			 their Employees, and Employees must enroll in the plan or waive participation.
			 Eligible Small Employers will be permitted to choose a Health Plan from among
			 those that the Health Connector makes available to the Small Employer. Eligible
			 Employers may allow Employees to choose among more than one Small Group Health
			 Plan in a manner specified by the Health Connector in accordance with
			 45
			 CFR 155.706(b). Employees
			 may select a Small Group Health Plan once the Eligible Small Employer completes
			 the employer portion of the application, and must complete plan selection by
			 the deadline determined by the Health Connector. Eligible Small Employers must
			 satisfy all applicable Connector contribution and participation requirements
			 and must pay the first month's Premium on or before a due date set by the
			 Connector in order to complete the Enrollment process. Premiums paid by Small
			 Employers must be the total Premium owed for all of the Small Employer's
			 participating Employees.
(2)
Enrollment Effective Date for Small-group Health
			 Plans
. Small Employers and Employees must complete the Enrollment
			 process in order to be covered in a Small Group Health Plan, including paying
			 all Premium owed by the due date set by the Connector. Coverage will begin on
			 the first day of the month following the completion of Enrollment, except that
			 in the case of a new enrollment resulting from birth, adoption or placement for
			 adoption or foster care of a child, the new dependent's effective date may be
			 the date of the birth, adoption or placement for adoption or foster care or the
			 first day of the month following the event, at the election of the
			 employee.
(3)
Annual
			 Open Enrollment for Eligible Small Employers
. Eligible Small
			 Employers may apply for coverage in a Small Group Health Plan at any time
			 during the year. From November 15th through December
			 15th of a given year, Small Employers that would be
			 eligible to participate but for the inability to satisfy any minimum
			 contribution and minimum participation requirements set forth in Connector
			 policy will be considered as eligible without having to satisfy such
			 requirements.
(4)
Open
			 Enrollment and Special Enrollment Periods for Employees
. Employees
			 may enroll during an annual enrollment period set by the Small Employer or at
			 the time of hiring or qualification for health benefits under the Employer's
			 rules. Employees who waived coverage shall be able to enroll in a Small Group
			 Health Plan, and enrolled Employees shall be able to transfer from one Small
			 Group Health Plan to a different Small Group Health Plan, or terminate their
			 Small Group Health Plan, during a special enrollment period established by the
			 Connector if the Enrollee experiences a triggering event, and acts within
			 applicable time frames, as set forth in
			 45
			 CFR 155.726(j).
(5)
Termination of
			 Enrollees
. The Connector may terminate a Small Employer or
			 Employee from a Small Group Health Plan for the following reasons:
(a) For Fraud, including rescissions
			 consistent with
			 45 CFR
			 147.128;
(b) For failure of the Small Employer to pay
			 Premium under
			 956 CMR 12.12;
			 or
(c) When the Small Employer is
			 no longer eligible for coverage.