<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".10-1" citation="COMAR 31.17.03.10-1" title_num="31" subtitle_num="17" chapter_num="03" heading="Low-Income Subsidy.">
  <paragraph num="A.">
    <text>The Board may subsidize the premiums, deductibles, and other expenses of an individual based on the individual's income if the individual:</text>
    <paragraph num="(1)">
      <text>Is enrolled, or eligible to enroll, in the Plan;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Has an annual household income that is at or below a percentage of the federal poverty level established by the Board;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Submits to the plan administrator an application for the low-income subsidy on the form required by the Board; and</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Provides to the plan administrator verification of annual household income in a form acceptable to the Board.</text>
    </paragraph>
  </paragraph>
  <paragraph num="B.">
    <text>Initial Application.</text>
    <paragraph num="(1)">
      <text>An individual may apply for a low-income subsidy at any time.</text>
    </paragraph>
    <paragraph num="(2)">
      <text>If an applicant for a low-income subsidy fails to provide all of the required documentation, the plan administrator shall notify the applicant of:</text>
      <paragraph num="(a)">
        <text>The additional documentation that is required; and</text>
      </paragraph>
      <paragraph num="(b)">
        <text>The deadline set by the plan administrator for receipt of the additional documentation.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(3)">
      <text>If the applicant fails to provide the additional documentation by the deadline:</text>
      <paragraph num="(a)">
        <text>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</text>
      </paragraph>
      <paragraph num="(b)">
        <text>The applicant shall reapply for a low-income subsidy if the applicant wishes to receive future consideration for a low-income subsidy.</text>
      </paragraph>
    </paragraph>
  </paragraph>
  <paragraph num="C.">
    <text>Recertification.</text>
    <paragraph num="(1)">
      <text>Each year, the plan administrator shall mail a low-income subsidy recertification form to each member currently receiving a low-income subsidy.</text>
    </paragraph>
    <paragraph num="(2)">
      <text>The form shall require the member to provide to the plan administrator updated verification of annual household income:</text>
      <paragraph num="(a)">
        <text>In a form acceptable to the Board; and</text>
      </paragraph>
      <paragraph num="(b)">
        <text>That demonstrates continued eligibility for the low-income subsidy.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(3)">
      <text>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.</text>
    </paragraph>
    <paragraph num="(4)">
      <text>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.</text>
    </paragraph>
  </paragraph>
  <paragraph num="D.">
    <text>Enrollment Capacity.</text>
    <paragraph num="(1)">
      <text>The Board shall determine the number of members who may receive the low-income subsidy each year.</text>
    </paragraph>
    <paragraph num="(2)">
      <text>If the Board determines that the maximum number of members are receiving the low-income subsidy for a year, the plan administrator shall:</text>
      <paragraph num="(a)">
        <text>Discontinue granting the low-income subsidy; and</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Establish a waiting list of individuals who are eligible for the low-income subsidy.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(3)">
      <text>An individual on the waiting list may enroll in a standard Plan design option until a low-income subsidy becomes available to the individual.</text>
    </paragraph>
  </paragraph>
  <paragraph num="E.">
    <text>Fraud.</text>
    <paragraph num="(1)">
      <text>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.</text>
    </paragraph>
    <paragraph num="(2)">
      <text>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.</text>
    </paragraph>
  </paragraph>
</regulation>