956 CMR, § 12.10 - Enrollment in, Open Enrollment and Special Enrollment Periods Applicable to, and Termination from Non-group Health Plans

(1) Open Enrollment and Special Enrollment Periods for Non-group Health Plans. Eligible Individuals may enroll in a Non-group Health Plan, and Enrollees may transfer from one Non-group Health Plan to a different Non-group Health Plan, as made available to that Eligible Individual or Enrollee through the Health Connector, during any open enrollment periods established by state or federal law. Eligible Individuals may enroll in a Non-group Health Plan, and Enrollees may transfer from one Non-group Health Plan to a different available Non-group Health Plan, outside of the open enrollment period only during a special enrollment period established by the Connector for one of the following reasons:

(a) The Enrollee experiences a triggering event, as set forth in 45 CFR 155.420 and applicable state law including, but not limited to, enrollment waivers available under 958 CMR 4.00: Health Insurance Open Enrollment Waivers;

(b) An individual is determined newly eligible for a ConnectorCare plan in accordance with 956 CMR 12.04(3);

(c) The Enrollee's eligibility changes Plan Types in accordance with 956 CMR 12.04(3);

(d) The Enrollee's eligibility changes from being eligible for ConnectorCare to being eligible for a Non-group Health Plan with APTC Only;

(e) The Enrollee has been approved for a hardship waiver in accordance with 956 CMR 12.12; or

(f) The Enrollee's hardship waiver period has ended.

Enrollees will have 60 days to enroll in a Health Plan from the date of one of the events in 956 CMR 12.10(1)(a) through (f).

(2) Enrollment in Non-group Health Plans. Eligible Individuals who may enroll under 956 CMR 12.10(1) will be permitted to choose a Health Plan from among those that are made available to them through the Health Connector, and must choose a Health Plan in order to be enrolled. Eligible Individuals who are required to pay a Premium 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 for a Non-group Health Plan shall be the full cost of such Health Plan, and Premiums for Non-group Health Plans with Financial Assistance shall be the cost of such Health Plans reduced by the amounts of any applicable APTC and Premium Assistance.

(3) Enrollment Effective Date for Non-group Health Plans. Eligible Individuals must complete the Enrollment process in order to be covered in a Non-group Health Plan, including paying any required premium by the due date set by the Connector. Coverage will begin on the first day of the month following the completion of Enrollment, including payment of Premium by the due date, except that in the case of the addition of a dependent to an existing enrollment resulting from the birth, adoption or placement for adoption or foster care of the new dependent, the new dependent's effective date may alternately be the date of the birth, adoption or placement for adoption or foster care. Eligible Individuals who do not pay any required premium by the due date set by the Connector shall not be enrolled in coverage, unless otherwise permitted to enroll at a future date in accordance with 956 CMR 12.10(4).

(4) Notification. The Connector will notify an Enrollee in writing of the name and contact information of the Enrollee's Health Plan and enrollment effective date.

(5) Termination of Enrollees. The Connector may terminate an Enrollee in accordance with any applicable grace periods as set forth in 45 CFR 156.270(d) and (g) and any applicable state law, for the following reasons:

(a) For Fraud, including rescissions consistent with 45 CFR 147.128;

(b) For failure to pay Premiums under 956 CMR 12.12; or

(c) When the Enrollee is no longer eligible for coverage.

(6) If the Connector terminates an Enrollee pursuant to 956 CMR 12.10(5), it will provide the enrollee with written notice stating the reason for the action.

(7) The Connector may recoup any monies paid on behalf of an Enrollee to a Health Carrier for a Health Plan from the Enrollee directly if the enrollee is terminated for Fraud.

(8) Voluntary Termination of Coverage. If a Non-group Health Plan Enrollee wishes to voluntarily terminate coverage, it is the Enrollee's responsibility to notify the Connector of such. The Connector shall establish a date during a month by which an Enrollee must request termination in order for the termination to be effective at the end of the month in which it is requested. A termination request made after such a date shall be effective at the end of the month following the month in which it was requested, unless coverage is terminated earlier for another reason unrelated to the request to voluntarily terminate. Any Enrollee who requests termination of coverage shall be responsible for any Premium owed for all coverage months.

Notes

956 CMR, § 12.10

Amended by Mass Register Issue 1418, eff. 5/29/2020.