1. A. The Board may subsidize the premiums, deductibles, and other expenses of an individual based on the individual's income if the individual:

   1. (1) Is enrolled, or eligible to enroll, in the Plan;
   2. (2) Has an annual household income that is at or below a percentage of the federal poverty level established by the Board;
   3. (3) Submits to the plan administrator an application for the low-income subsidy on the form required by the Board; and
   4. (4) Provides to the plan administrator verification of annual household income in a form acceptable to the Board.

2. B. Initial Application.

   1. (1) An individual may apply for a low-income subsidy at any time.

   2. (2) If an applicant for a low-income subsidy fails to provide all of the required documentation, the plan administrator shall notify the applicant of:

      1. (a) The additional documentation that is required; and
      2. (b) The deadline set by the plan administrator for receipt of the additional documentation.

   3. (3) If the applicant fails to provide the additional documentation by the deadline:

      1. (a) The plan administrator shall notify the applicant that the applicant has not demonstrated eligibility for the low-income subsidy and bill the applicant for standard Plan enrollment; and
      2. (b) The applicant shall reapply for a low-income subsidy if the applicant wishes to receive future consideration for a low-income subsidy.

3. C. Recertification.

   1. (1) Each year, the plan administrator shall mail a low-income subsidy recertification form to each member currently receiving a low-income subsidy.

   2. (2) The form shall require the member to provide to the plan administrator updated verification of annual household income:

      1. (a) In a form acceptable to the Board; and
      2. (b) That demonstrates continued eligibility for the low-income subsidy.
   3. (3) If a member who is receiving a low-income subsidy fails to demonstrate continued eligibility for the low-income subsidy, the member may select a standard Plan design option during open enrollment.
   4. (4) If a member who fails to demonstrate continued eligibility for the low-income subsidy fails to select a standard Plan design option during open enrollment, the plan administrator shall place the member in a Plan design option in accordance with standards established by the Board.

4. D. Enrollment Capacity.

   1. (1) The Board shall determine the number of members who may receive the low-income subsidy each year.

   2. (2) If the Board determines that the maximum number of members are receiving the low-income subsidy for a year, the plan administrator shall:

      1. (a) Discontinue granting the low-income subsidy; and
      2. (b) Establish a waiting list of individuals who are eligible for the low-income subsidy.
   3. (3) An individual on the waiting list may enroll in a standard Plan design option until a low-income subsidy becomes available to the individual.

5. E. Fraud.

   1. (1) The plan administrator immediately shall cease the low-income subsidy to a member if the plan administrator determines that the member received the low-income subsidy based on fraudulent documentation or statements, including any material misrepresentation but for which the member would not have received the low-income subsidy.
   2. (2) The Plan may recover from any member or former member the amount of any low-income subsidy that the member or former member received due to the Plan's reliance on a material misrepresentation by the member or former member.

Authority: Insurance Article, §14-503(k), Annotated Code of Maryland

Effective date:

Regulations .01—.19 adopted as an emergency provision effective April 8, 2003 (30:9 Md. R. 609); emergency text amended effective July 1, 2003 (30:16 Md. R. 1072); adopted permanently effective December 22, 2003 (30:25 Md. R. 1851)

Regulation .01B amended effective May 21, 2007 (34:10 Md. R. 891)

Regulation .02B amended effective February 22, 2010 (37:4 Md. R. 343); August 9, 2010 (37:16 Md. R. 1060); January 7, 2013 (39:26 Md. R. 1666)

Regulation .10E amended effective January 7, 2013 (39:26 Md. R. 1666)

Regulation .10-1 adopted effective May 21, 2007 (34:10 Md. R. 891)

Regulation .12C amended effective January 30, 2006 (33:2 Md. R. 85)

Regulation .14 amended effective May 4, 2009 (36:9 Md. R. 654); February 22, 2010 (37:4 Md. R. 343)