Code of Maryland Regulations
Title 10 - MARYLAND DEPARTMENT OF HEALTH
Part 2
Subtitle 09 - MEDICAL CARE PROGRAMS
Chapter 10.09.41 - Employed Individuals with Disabilities
Section 10.09.41.07 - Premium
Universal Citation: MD Code Reg 10.09.41.07
Current through Register Vol. 51, No. 19, September 20, 2024
A. Submission of Premium.
(1) Unless an exception under
§A(2) of this regulation applies or a timely claim of hardship is raised
pursuant to §C of this regulation, an applicant or recipient shall, as a
condition of eligibility for the EID coverage group, pay the premium specified
in §A(3) of this regulation.
(2) Limitation of Premium Requirement.
(a) An applicant or recipient with income at
or below the federal poverty level is not required to pay a premium as a
condition of eligibility in the EID coverage group.
(b) With respect to an applicant determined
eligible subject to the requirements of §A(3) of this regulation, the
Department shall waive the premium payment before the notice of eligibility for
a period not to exceed 6 months if such notice of eligibility is delayed by
factors beyond the applicant's control.
(3) An applicant or participant whose
assistance unit has income:
(a) Above the
federal poverty level, but at or below 200 percent of the federal poverty
level, shall pay a monthly premium of $25;
(b) Above 200 percent, but at or below 250
percent of the federal poverty level, shall pay a monthly premium of $40;
(c) Above 250 percent, but at or
below 300 percent of the federal poverty level, shall pay a monthly premium of
$55;
(d) Above 300 percent, but at
or below 450 percent of the federal poverty level, shall pay a monthly premium
of 4 percent of the monthly net countable income determined under Regulation
.04B of this chapter;
(e) Above 450
percent, but at or below 600 percent of the federal poverty level, shall pay a
monthly premium of 5 percent of the monthly net countable income determined
under Regulation .04B of this chapter; or
(f) Above 600 percent of the federal poverty
level, shall pay a monthly premium of 7.5 percent of the monthly net countable
income determined under Regulation .04B of this chapter.
(4) Annual Premium Adjustment. Beginning
March 1, 2014, and as of March 1 of each year thereafter, the Department shall
recalculate the premium amounts set forth in §A(3) of this regulation and
adjust them to reflect the federal poverty level then in effect.
(5) An applicant or recipient to whom
§A(3) of this regulation applies shall, within 30 days of the Department's
request for payment pursuant to Regulation §A(4) of this regulation:
(a) Pay the full premium due as specified in
the request for payment issued pursuant to §A(4) of this regulation;
or
(b)
§A(3)(b) of this
regulation, at 200 percent of the federal poverty level then in effect;
or
(c)
§A(3)(c) of this
regulation, at 250 percent of the federal poverty level then in
effect.
(6) Request for
Payment. With respect to an applicant or recipient determined eligible subject
to the requirements of §A(3) of this regulation, the Department shall
issue a request for payment of the applicable premium, indicating that the
applicant or recipient shall pay the amount specified within 30 days of the
date the Department mailed the request for payment.
(7) An applicant or recipient to whom
§A(3) of this regulation applies shall, within 30 days of the Department's
request for payment pursuant to Regulation §A(6) of this regulation:
(a) Pay the full premium due as specified in
the request for payment issued pursuant to §A(6) of this regulation;
or
(b) Submit a claim of hardship
as authorized by §C of this regulation.
(8) Upon request by the recipient, the
Department shall approve an unemployment grace period, not to exceed 6 months
within a 12-month period, provided the recipient:
(a) Has unemployment due to medical reasons
or involuntary job loss;
(b) Is
otherwise eligible for EID; and
(c)
Continues to pay the premium during the unemployment grace period.
B. Nonpayment of Premium.
(1) If an applicant who is required
to pay a premium under §A(3) of this regulation, and is the subject of a
request for payment issued by the Department pursuant to Regulation §A(4)
of this regulation, does not pay the premium or submit a hardship claim within
30 days of the Department's notice, the Department shall:
(a) Determine the applicant is not eligible
for the EID coverage group; and
(b)
Issue a denial notice as required by Regulation .08C(1) of this
chapter.
(2) If recipient
who is required to pay a premium under §A(3) of this regulation, and is
the subject of a request for payment issued by the Department pursuant to
Regulation §A(4) of this regulation, does not pay the premium or submit a
hardship claim within 30 days of the Department's notice, the Department shall:
(a) Determine the recipient is not eligible
for the EID coverage group;
(b)
Issue a termination notice as required by Regulation .08C(2) of this chapter;
and
(c) Refer the recipient to the
Central Collection Unit.
(3) An applicant or recipient whose
eligibility is denied or terminated due to failure to pay the premium as
specified in §A(4) of this regulation may not be reenrolled in the EID
coverage group until the applicant or recipient pays all monies due to the
Department in full.
C. Hardship.
(1) If the applicant or recipient
suffers financial adversity or misfortune so severe that payment of the premium
would compromise the applicant's or recipient's ability to obtain and provide
basic food, shelter, and clothing for members of the assistance unit or other
legal dependents of the applicant or recipient, the applicant or recipient may
submit a claim of hardship, specifying the underlying circumstances, to the
Department.
(2) The Department
shall evaluate the claim of hardship and notify the applicant or recipient of
its decision within 30 days of the Department's receipt of the written claim of
hardship.
(3) If the Department
determines that the applicant or recipient's claim of hardship is without
merit, the applicant or recipient shall pay the applicable premium within 10
days after the date the Department's notice is issued pursuant to §C(2) of
this regulation.
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