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<regulation prefix="Regulation" num=".05" citation="COMAR 14.35.18.05" title_num="14" subtitle_num="35" chapter_num="18" heading="Termination, Cancellation, and Renewal of Qualified Health Plan.">
  <paragraph num="A.">
    <text>Termination.</text>
    <paragraph num="(1)">
      <text>A qualified employer who participates in the SHOP and who terminates SHOP coverage terminates the enrollment of the employees enrolled in plans under the SHOP.</text>
    </paragraph>
    <paragraph num="(2)">
      <text>An employee who is the certificate holder of a qualified health plan purchased through the SHOP, who terminates enrollment in a qualified health plan also terminates the enrollment of the other enrollees in the employee’s household.</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Each enrollee who is not the certificate holder may terminate enrollment in a qualified health plan without affecting the enrollment status of the employee’s household or each individual member of the employee’s household other than the enrollee.</text>
    </paragraph>
    <paragraph num="(4)">
      <text>A carrier shall process the SHOP Exchange’s termination determination promptly and without undue delay.</text>
    </paragraph>
    <paragraph num="(5)">
      <text>A carrier shall maintain records of termination of enrollment in a qualified health plan in the format specified by the SHOP Exchange in an electronic data interchange format for a period of 10 years.</text>
    </paragraph>
    <paragraph num="(6)">
      <text>A carrier shall make reasonable accommodations for all individuals with disabilities (as defined by the Americans with Disabilities Act), including head-of-household and non-head-of-household enrollees, before terminating the individual’s enrollment.</text>
    </paragraph>
    <paragraph num="(7)">
      <text>A carrier shall send an electronic transaction to the SHOP Exchange documenting, or acknowledging, each termination of coverage carried out under this chapter, promptly and without undue delay.</text>
    </paragraph>
  </paragraph>
  <paragraph num="B.">
    <text>Termination by the SHOP Exchange.</text>
    <paragraph num="(1)">
      <text>Termination Due to Failure to Pay.</text>
      <paragraph num="(a)">
        <text>If payment for a group is not received by the end of the grace period stated in the group contract, the SHOP Exchange may terminate the group’s coverage.</text>
      </paragraph>
      <paragraph num="(b)">
        <text>The last day of coverage shall be the last day of the grace period stated in the group contract or first day of the coverage month.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>Termination Due to Error, Misconduct, Fraud, or Misrepresentation of a Group. Coverage may be retroactively terminated if:</text>
      <paragraph num="(a)">
        <text>The enrollment in a qualified health plan through the SHOP Exchange was unintentional, inadvertent, or erroneous and was the result of the error or misconduct of an officer, employee, or agent of the SHOP Exchange, its instrumentalities, or a non-Exchange entity providing enrollment assistance or conducting enrollment activities;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>The employee or group was enrolled in a qualified health plan without the employee or group’s knowledge or consent by any third party, including third parties who have no connection with the SHOP Exchange; or</text>
      </paragraph>
      <paragraph num="(c)">
        <text>The eligibility determination was made based on information regarding the group that is false or misrepresentative of the actual composition of the group.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(3)">
      <text>Notification of Termination.</text>
      <paragraph num="(a)">
        <text>If any employee’s coverage or enrollment through the SHOP is terminated due to nonpayment of premiums or due to a loss of the employee’s eligibility to participate in the SHOP, including the coverage of an employee who loses eligibility because a qualified employer has lost its eligibility, the SHOP shall notify the employee of the termination.</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Such notice of termination shall include the termination effective date and reason for termination, and shall be sent within 3 business days if an electronic notice is sent, and within 5 days if a mailed hard copy notice is sent.</text>
      </paragraph>
    </paragraph>
  </paragraph>
  <paragraph num="C.">
    <text>Renewal, Nonrenewal, and Cancellation. Renewal, nonrenewal, and cancellation shall be conducted in accordance with the requirements of Insurance Article, §15-1212, Annotated Code of Maryland.</text>
  </paragraph>
</regulation>