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

(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 15^th through December 15^th 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.

(6) If the Connector terminates a Small Employer or an Enrollee pursuant to 956 CMR 12.11(5), it will provide the Small Employer or Enrollee with written notice stating the reason for the action.

(7) Voluntary Termination of Coverage. If a Small Employer wishes to voluntarily terminate coverage, it is the Small Employer's responsibility to notify the Connector of such. The Connector shall establish a date during a month by which a Small Employer 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 Small Employer who requests termination of coverage shall be responsible for any premium owed for all coverage months. As stated in 956 CMR 12.11(4) an Employee or dependent Enrollee may only terminate coverage during a special enrollment period.

Notes

956 CMR, § 12.11

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