Code of Massachusetts Regulations
956 CMR - COMMONWEALTH HEALTH INSURANCE CONNECTOR AUTHORITY
Title 956 CMR 12.00 - Eligibility, Enrollment, and Hearing Process for Connector Programs
Section 12.12 - Premiums, Delinquency, and Reinstatement
Current through Register 1531, September 27, 2024
(1) Enrollee and Small Employer Premiums. Enrollees who are assessed a Premium and Small Employers are responsible for monthly payments that must be paid on or before a due date set by the Connector. The Connector will establish and maintain multiple convenient payment methods for Enrollees and Small Employers. The Connector will transmit Premium payments received from Enrollees or Small Employers to the Health Plans in which they are enrolled.
(2) Delinquent Enrollee Premiums for Non-group Health Plans without Financial Assistance. An Enrollee in a Non-group Health Plan without Financial Assistance who fails to pay a monthly Enrollee Premium in full by the payment due date will be considered delinquent and will be notified when the account is past due. This notice of delinquency will inform the Enrollee that, if payment of all outstanding Premium is not received in full on or before the payment due date indicated in the notice, then the coverage will be terminated retroactively to the last day of the last month for which the Enrollee has paid for coverage in full.
(3) Termination from a Non-group Health Plans without Financial Assistance for Failure to Pay Enrollee Premiums. If a delinquent Enrollee in a Non-group Health Plan has not paid outstanding Premiums in full by the due date indicated in the notice of delinquency, then the coverage is terminated retroactively to the last day of the last month for which the Enrollee has paid for coverage in full. The Connector shall notify the Enrollee of the termination.
(4) Delinquent Enrollee Premiums for Non-group Health Plans with Financial Assistance. An Enrollee in a Health Plan with APTC Only or in ConnectorCare who fails to pay a monthly Premium in full by the payment due date will be considered delinquent and will be notified when the account is past due. If an Enrollee's account is delinquent for two consecutive months, the Enrollee will be notified by a notice of delinquency which will inform the Enrollee that, if payment of all outstanding Premium is not received in full on or before the payment due date indicated in the notice, then the coverage will be terminated retroactively to the last day of the first coverage month in which the Enrollee was delinquent.
(5) Termination from a Non-group Health Plan with Financial Assistance for Failure to Pay Enrollee Premiums. If an Enrollee who is delinquent fails to pay all Premiums owed in full by the due date after receiving the second notice described in 956 CMR 12.12(4), then the coverage is terminated retroactively to the last day of the first coverage month in which the Enrollee was delinquent. The Enrollee will be notified of the termination with a notice of termination.
(6) Reinstating Coverage in a Non-Group Health Plan Following Termination for Failure to Pay Premiums. An Enrollee in a Non-Group Health Plan who was terminated for non-payment of Premium and who makes a timely request to reinstate coverage may do so, provided that all outstanding Premiums for such terminated Enrollee have been paid in full, as well as the next month's Premium, by the deadline determined by the Connector.
(7) Waiver or Reduction of Premium for Extreme Financial Hardship.
(8) Change in Premium for Non-group Health Plans.
(9) Minimum Monthly ConnectorCare Premium Schedule. The Board shall determine annually the minimum monthly Premium for each Plan Type. The Premiums shall be set forth in a schedule that will be published annually.
(10) Monthly ConnectorCare Premium Assistance Payments. The Connector will make Premium Assistance payments to Health Carriers for Health Plans on behalf of ConnectorCare Enrollees monthly, using funds appropriated by the Commonwealth for the purpose, or otherwise made available to the Connector.
(11) Delinquent Small Employer Premiums for Small Group Health Plans. A Small Employer that fails to pay its monthly Premiums in full by the payment due date will be considered delinquent and will be notified when its account is past due. This notice of delinquency will inform the Small Employer that, if payment of all outstanding monthly Premium is not received in full on or before the payment due date indicated in the notice, then the coverage will be terminated retroactively to the last day of the last month for which the Small Employer has paid for coverage in full.
(12) Termination from a Small Group Health Plan for Failure to Pay Premiums. If a delinquent Small Employer has not paid its outstanding Premiums in full by the due date indicated in the notice of delinquency, then the coverage is terminated retroactively to the last day of the last month for which the Small Employer has paid for coverage in full. The Small Employer and any Enrolled Employees will be notified of the termination with a notice of termination.
(13) Reinstating Coverage in a Small Group Health Plan following Termination for Failure to Pay Premiums. A Small Employer that was terminated for non-payment of Premiums may reinstate coverage within 30 days from the date coverage was terminated. All outstanding monthly Premium must be paid in full as well as the Premium for the following month of coverage.