1. A. The Exchange shall redetermine the eligibility of a qualified individual on an annual basis as specified in 45 CFR §155.335.
2. B. The Exchange shall provide a qualified individual with an annual redetermination notice as specified in 45 CFR §155.335(c) that adheres to the timing specified in 45 CFR §155.335(d).
3. C. If an enrollee remains eligible for enrollment in a QHP through the Exchange upon annual redetermination, the Exchange shall re-enroll the enrollee according to 45 CFR §155.335(j), except as provided for in §E of this regulation.

4. D. Consumers eligible for re-enrollment may:

   1. (1) Change their plan during open enrollment;

   2. (2) If ineligible for automatic re-enrollment, manually re-enroll coverage by:

      1. (a) Re-enrolling online through the Maryland Health Connection Consumer Portal;
      2. (b) Re-enrolling with the assistance of an Individual Exchange Navigator, certified application counselor, or insurance producer; or
      3. (c) Calling the MHC call center; or
   3. (3) Decline re-enrollment.

5. E. Re-Enrollment into Higher Value Plans.

   1. (1) Unless the enrollee terminates coverage, including termination of coverage in connection with voluntarily selecting a different QHP in accordance with 45 CFR §155.430, the exchange shall follow the procedure detailed in §E(2) of this regulation to re-enroll an enrollee into a plan other than the enrollee's original plan or plan identified by the carrier pursuant to §F of this regulation if the enrollee:

      1. (a) Remains eligible for enrollment in a QHP through the Exchange upon annual redetermination;
      2. (b) Is determined, upon annual redetermination, eligible for cost-sharing reductions in accordance with 45 CFR §155.305(g);
      3. (c) Is currently enrolled in a bronze level QHP that is not a high deductible health plan compatible with a health savings account as defined in 26 U.S.C. §223; and
      4. (d) Would be re-enrolled in a bronze level QHP that is not a high deductible health plan compatible with a health savings account as defined in 26 U.S.C. §223 under §B of this regulation.

   2. (2) The Exchange shall re-enroll enrollees that meet the criteria of §E(1) of this regulation in the QHP:

      1. (a) With the highest actuarial value available;
      2. (b) Within the same product;
      3. (c) With the same provider network; and

      4. (d) Which, compared to the original bronze level QHP into which the Exchange would otherwise re-enroll the enrollee under §B of this regulation, and after the application of advance payment of the premium tax credit and young adult subsidy under COMAR 14.35.19, has a premium that is:

         1. (i) Lower; or
         2. (ii) Equivalent.
6. F. For QHPs that carriers plan to discontinue, enrollees in those QHPs shall be re-enrolled into QHPs determined by carrier-submitted plan re-enrollment templates according to COMAR 14.35.15.05O.

Authority: Insurance Article, §31-106(c)(1)(iv), Annotated Code of Maryland

Effective date: April 15, 2013 (40:7 Md. R. 612)

Regulation .01 repealed and new Regulations .01—.21 adopted effective March 11, 2019 (46:5 Md. R. 307)

Regulation .02B amended effective November 29, 2021 (48:24 Md. R. 1025)

Regulation .08 amended effective February 19, 2024 (51:3 Md. R.154)

Regulation .08E amended effective February 17, 2025 (52:3 Md. R. 160)

Regulation .11B, D amended effective June 13, 2022 (49:12 Md. R. 642)

Regulation .11F amended effective February 17, 2025 (52:3 Md. R. 160)

Regulation .12 amended effective June 13, 2022 (49:12 Md. R. 642)

Regulation .12E amended effective February 17, 2025 (52:3 Md. R. 160)

Regulation .12E, F amended effective February 19, 2024 (51:3 Md. R.154)

Regulation .13B, E amended effective June 13, 2022 (49:12 Md. R. 642)

Regulation .13E amended effective February 17, 2025 (52:3 Md. R. 160)

Regulation .14E amended effective February 19, 2024 (51:3 Md. R.154)

Regulation .14G adopted effective February 19, 2024 (51:3 Md. R.154)

Regulation .18A, D amended effective June 13, 2022 (49:12 Md. R. 642)

Regulation .18D amended effective February 17, 2025 (52:3 Md. R. 160)

Regulation .19 amended effective June 13, 2022 (49:12 Md. R. 642)

Regulation .19M, O amended effective February 17, 2025 (52:3 Md. R. 160)

Regulation .19 N amended effective February 19, 2024 (51:3 Md. R.154)

Regulation .22 adopted as an emergency provision effective May 10, 2023 (50:11 Md. R. 444); adopted permanently effective October 16, 2023 (50:20 Md. R. 889)

Regulation .23 adopted effective August 5, 2024 (51:15 Md. R. 710)