When a State imposes premiums, enrollment fees, or similar fees on enrollees, the State plan must describe—

1. (a) The amount of the premium, enrollment fee or similar fee imposed on enrollees;
2. (b) The time period for which the charge is imposed;
3. (c) The group or groups that are subject to the premiums, enrollment fees, or similar charges;
4. (d) The consequences for an enrollee or applicant who does not pay a charge, and the disenrollment protections adopted by the State in accordance with § 457.570; and
5. (e) The methodology used to ensure that total cost-sharing liability for a family does not exceed the cumulative cost-sharing maximum specified in § 457.560.