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<regulation prefix="Regulation" num=".09" citation="COMAR 10.25.01.09" title_num="10" subtitle_num="25" chapter_num="01" heading="Renewal Application.">
  <paragraph num="A.">
    <text>The enrolled employer shall complete a renewal application published on the Commission's official website. The renewal application shall include:</text>
    <paragraph num="(1)">
      <text>Information necessary to establish the eligibility of the employer and the amount of the available premium subsidy;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>An acknowledgement that the Commission may request that certain records be produced and made available;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>An affidavit signed by the enrolled employer that the information in the renewal application is correct and that the enrolled employer meets the eligibility criteria for receipt of a premium subsidy; and</text>
    </paragraph>
    <paragraph num="(4)">
      <text>An affidavit signed by the enrolled employer that the enrolled employer has had a Section 125 payroll deduction plan in place over the 10-month period immediately preceding the planned date of premium subsidy renewal.</text>
    </paragraph>
  </paragraph>
  <paragraph num="B.">
    <text>The renewal application shall include an affirmation signed by the licensed insurance producer that:</text>
    <paragraph num="(1)">
      <text>The health benefit plan or plans selected by the enrolled employer include a wellness benefit;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>The licensed insurance producer has examined the enrolled employer's most recent Quarterly Wage Report, and the information in the renewal application is consistent with that report; and</text>
    </paragraph>
    <paragraph num="(3)">
      <text>To the best of the licensed insurance producer's knowledge, the information in the renewal application is correct.</text>
    </paragraph>
  </paragraph>
  <paragraph num="C.">
    <text>The renewal application shall include a signed form from each employee applying for the Premium Subsidy Program who was either not insured under the employer's health benefit plan during the previous policy year or who is changing coverage from individual coverage to other than individual coverage. The form shall include:</text>
    <paragraph num="(1)">
      <text>Information about any private or public health insurance program that provided coverage at any time during the preceding 3 months for the employee or any of the employee's dependents who will be covered under the enrolled employer's health benefit plan; and</text>
    </paragraph>
    <paragraph num="(2)">
      <text>If the type of coverage is for other than individual coverage:</text>
      <paragraph num="(a)">
        <text>An affidavit that the employee's family adjusted gross income is less than the maximum income for other than individual coverage; and</text>
      </paragraph>
      <paragraph num="(b)">
        <text>An agreement to provide copies of relevant tax return forms, if requested by the Commission.</text>
      </paragraph>
    </paragraph>
  </paragraph>
  <paragraph num="D.">
    <text>The Commission's registry will generate:</text>
    <paragraph num="(1)">
      <text>A registration number;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>The total premium subsidy that the participating carrier shall provide to the small employer in the form of reduced total premium;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Total premium subsidy for each enrolled employee that the small employer shall pass through in the form of reduced payroll deductions for health benefits; and</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Other information that the Commission may consider useful for administration of the Premium Subsidy Program.</text>
    </paragraph>
  </paragraph>
  <paragraph num="E.">
    <text>The participating carrier's procedures and written participation agreement determines whether the licensed insurance producer, the subsidy administrator, or the participating carrier shall enter the information from the renewal application in the Commission registry to register the enrolled employer to receive a premium subsidy.</text>
  </paragraph>
</regulation>