# COMAR Title 14 — Independent Agencies

## Subtitle 35 — Maryland Health Benefit Exchange

### Chapter 07 — Eligibility Standards for Enrollment in a Qualified Health Plan, Eligibility Standards for APTC and CSR, and Eligibility Standards for Enrollment in a Catastrophic Qualified Health Plan in the Individual Exchange

#### Regulation .23 QHP Re-Enrollments—In General.

*COMAR 14.35.07.23*

A. The Exchange shall redetermine the eligibility of a qualified individual on an annual basis as specified in 45 CFR §155.335.

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).

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.

D. Consumers eligible for re-enrollment may:

  (1) Change their plan during open enrollment;

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

    (a) Re-enrolling online through the Maryland Health Connection Consumer Portal;

    (b) Re-enrolling with the assistance of an Individual Exchange Navigator, certified application counselor, or insurance producer; or

    (c) Calling the MHC call center; or

  (3) Decline re-enrollment.

E. Re-Enrollment into Higher Value Plans.

  (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:

    (a) Remains eligible for enrollment in a QHP through the Exchange upon annual redetermination;

    (b) Is determined, upon annual redetermination, eligible for cost-sharing reductions in accordance with 45 CFR §155.305(g);

    (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

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

    (a) With the highest actuarial value available;

    (b) Within the same product;

    (c) With the same provider network; and

    (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:

      (i) Lower; or

      (ii) Equivalent.

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.