Current through Register Vol. 51, No. 19, September 20, 2024
A. The
enrolled employer shall complete a renewal application published on the
Commission's official website. The renewal application shall include:
(1) Information necessary to establish the
eligibility of the employer and the amount of the available premium
subsidy;
(2) An acknowledgement
that the Commission may request that certain records be produced and made
available;
(3) 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
(4) 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.
B. The renewal application shall include an
affirmation signed by the licensed insurance producer that:
(1) The health benefit plan or plans selected
by the enrolled employer include a wellness benefit;
(2) 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
(3) To the best of the licensed
insurance producer's knowledge, the information in the renewal application is
correct.
C. 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:
(1) 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
(2) If the type of coverage is
for other than individual coverage:
(a) An
affidavit that the employee's family adjusted gross income is less than the
maximum income for other than individual coverage; and
(b) An agreement to provide copies of
relevant tax return forms, if requested by the Commission.
D. The Commission's registry will
generate:
(1) A registration number;
(2) The total premium subsidy that the
participating carrier shall provide to the small employer in the form of
reduced total premium;
(3) 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
(4) Other information that the
Commission may consider useful for administration of the Premium Subsidy
Program.
E. 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.
