(1) As
grounds for the hardship appeal, the Appellant must establish that, based on
all his circumstances, health insurance that provided minimum creditable
coverage was not affordable to him because he experienced a hardship. In
determining whether a hardship existed, the Connector shall consider whether,
within the tax year for which the penalty was assessed, the Appellant:
(a) was homeless, or was more than 30 days in
arrears in rent or mortgage payments, or received an eviction or foreclosure
notice;
(b) received a shut-off
notice, or was shut off, or was refused the delivery of essential utilities
(gas, electric, oil, water, or telephone);
(c) for the period ending December 31, 2008,
had non-cosmetic medical and/or dental out-of-pocket expenses (exclusive of
premium payments), totaling more than 7.5% of his household's adjusted gross
income that were not subject to payment by a third-party;
(d) incurred a significant, unexpected
increase in essential expenses resulting directly from the consequences of:
1. domestic violence;
2. the death of a spouse, family member, or
partner with primary responsibility for child care where that spouse, family
member or partner had shared household expenses;
3. the sudden responsibility for providing
full care for an aging parent or other family member, including a major,
extended illness of a child that requires a working parent to hire a full-time
caretaker for the child; or
4. a
fire, flood, natural disaster, or other unexpected natural or human-caused
event causing substantial household or personal damage for the individual
filing the appeal; or
(e) experienced financial circumstances such
that the expense of purchasing health insurance that met minimum creditable
coverage standards would have caused him to experience a serious deprivation of
food, shelter, clothing or other necessities.
(2) Inconsidering whether the Appellant could
afford insurance that met minimum creditable coverage standards, the Connector
may also consider, with respect to the tax year for which the penalty was
assessed:
(a) Whether the Appellant had access
to a Section 125 Plan through an employer;
(b) Whether the Appellant had access to
health insurance through an employer, union or other group and, if so, whether
that insurance met minimum creditable coverage standards and what was the cost
of that insurance (including the premiums, deductibles, copayments and
co-insurance);
(c) If the Appellant
purchased health insurance, what was the cost to the Appellant of that
insurance, including the premiums, deductible, copayment and
co-insurance;
(d) If the Appellant
purchased health insurance, the extent to which it deviated from or
substantially met minimum creditable coverage standards;
(e) When the Appellant last had the
opportunity to purchase insurance through an employer, relative to July 1,
2007, the effective date of the requirement to obtain health insurance under
M.G.L. c. 111M.; and
(f) Whether
Appellant's family size was so large that reliance on the affordability
schedule for a family would result in a significant inequity
(3) The Connector shall consider
any other grounds that an Appellant may claim demonstrates that he could not
afford to purchase health insurance that met minimum creditable coverage
standards.
