1. A. A carrier may only terminate an individual’s coverage in a QHP before receiving an instruction from the Exchange to terminate coverage:

   1. (1) If the enrollee requests termination of the enrollee’s enrollment to the carrier, and the termination follows the procedures in Regulation .04 of this chapter;
   2. (2) If the enrollee’s coverage is rescinded under 45 CFR §147.128;
   3. (3) If the carrier is decertified by the Exchange under COMAR 14.35.16.11;
   4. (4) If the carrier ceases to offer the QHP that an enrollee is enrolled in through the Exchange under 45 CFR §147.106(b)(4) and the carrier follows the requirements under 45 CFR §147.106(c);
   5. (5) If the carrier ceases to offer any QHPs through the Exchange under 45 CFR §147.106(b)(4) and the carrier follows the requirements under 45 CFR §147.106(d);
   6. (6) If the enrollee has performed an act or practice that constitutes fraud or intentional misrepresentation of material fact in connection with the coverage under 45 CFR §147.106(b)(2); or
   7. (7) For nonpayment of premiums as specified in §B of this regulation.

2. B. Termination for Nonpayment.

   1. (1) A carrier may terminate coverage for nonpayment of premium if the enrollee has not made applicable premium payments and at the time the enrollee first fails to pay premiums:

      1. (a) The enrollee is receiving APTC, and the 3-month grace period under Insurance Article, §15-1315(c)—(e), Annotated Code of Maryland, has been exhausted; or
      2. (b) The enrollee is not receiving APTC and all other applicable grace periods under State law have been exhausted.

   2. (2) A carrier may not terminate coverage for failure to make a premium payment if:

      1. (a) Through a renewal of the plan under 45 CFR §155.335, the enrollee maintains coverage in the same QHP or same product that is a uniform modification of coverage under Insurance Article, §15-1309(a)(4), Annotated Code of Maryland; and

      2. (b) The applicable grace period has not been exhausted under:

         1. (i) Insurance Article, §15-1315(c)—(e), Annotated Code of Maryland; or
         2. (ii) Another applicable grace period under State law if the enrollee is not receiving APTC.

   3. (3) The last day of coverage is:

      1. (a) The last day of the first month of the 3-month grace period when terminating an individual after exhaustion of the 3-month grace period for individuals receiving APTC; and
      2. (b) 31 days after the missed premium payment was due when terminating an individual after the exhaustion of any other applicable grace period.
3. C. Notice of Non-Payment of Premiums. If an enrollee is delinquent on premium payment, the carrier shall provide the enrollee with notice of such payment delinquency. A carrier shall provide such notices promptly and without undue delay, within 10 business days of the date the issuer should have discovered the delinquency.

Authority: Insurance Article, §§31-106(c)(1)(iv) and 31-108(b)(1) and (6), Annotated Code of Maryland

Effective date: June 8, 2015 (42:11 Md. R. 726)

Regulations .01—.07 repealed and new Regulations .01—.10 adopted effective March 11, 2019 (46:5 Md. R. 308)

Regulation .04F adopted effective February 17, 2025 (52:3 Md. R. 160)

Regulation .06F adopted effective February 19, 2024 (51:3 Md. R.154)

Regulation .07C adopted effective February 19, 2024 (51:3 Md. R.154)