956 CMR, § 6.08 - Grounds for Hardship Appeal

(1) As grounds for the hardship appeal, the Appellant must establish that, based on all his circumstances, health insurance that provided minimum creditable coverage was not affordable to him because he experienced a hardship. In determining whether a hardship existed, the Connector shall consider whether, within the tax year for which the penalty was assessed, the Appellant:
(a) was homeless, or was more than 30 days in arrears in rent or mortgage payments, or received an eviction or foreclosure notice;
(b) received a shut-off notice, or was shut off, or was refused the delivery of essential utilities (gas, electric, oil, water, or telephone);
(c) for the period ending December 31, 2008, had non-cosmetic medical and/or dental out-of-pocket expenses (exclusive of premium payments), totaling more than 7.5% of his household's adjusted gross income that were not subject to payment by a third-party;
(d) incurred a significant, unexpected increase in essential expenses resulting directly from the consequences of:
1. domestic violence;
2. the death of a spouse, family member, or partner with primary responsibility for child care where that spouse, family member or partner had shared household expenses;
3. the sudden responsibility for providing full care for an aging parent or other family member, including a major, extended illness of a child that requires a working parent to hire a full-time caretaker for the child; or
4. a fire, flood, natural disaster, or other unexpected natural or human-caused event causing substantial household or personal damage for the individual filing the appeal; or
(e) experienced financial circumstances such that the expense of purchasing health insurance that met minimum creditable coverage standards would have caused him to experience a serious deprivation of food, shelter, clothing or other necessities.
(2) Inconsidering whether the Appellant could afford insurance that met minimum creditable coverage standards, the Connector may also consider, with respect to the tax year for which the penalty was assessed:
(a) Whether the Appellant had access to a Section 125 Plan through an employer;
(b) Whether the Appellant had access to health insurance through an employer, union or other group and, if so, whether that insurance met minimum creditable coverage standards and what was the cost of that insurance (including the premiums, deductibles, copayments and co-insurance);
(c) If the Appellant purchased health insurance, what was the cost to the Appellant of that insurance, including the premiums, deductible, copayment and co-insurance;
(d) If the Appellant purchased health insurance, the extent to which it deviated from or substantially met minimum creditable coverage standards;
(e) When the Appellant last had the opportunity to purchase insurance through an employer, relative to July 1, 2007, the effective date of the requirement to obtain health insurance under M.G.L. c. 111M.; and
(f) Whether Appellant's family size was so large that reliance on the affordability schedule for a family would result in a significant inequity
(3) The Connector shall consider any other grounds that an Appellant may claim demonstrates that he could not afford to purchase health insurance that met minimum creditable coverage standards.

Notes

956 CMR, § 6.08

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