20. At what other times may individuals lose eligibility?

The Connector may disenroll or terminate an enrollee at any other time during the benefit year for the following reasons:

  • For failure to pay enrollee premium contributions as required;
  • For fraud or abuse;
    •  An enrollee terminated for fraud may be subject to recoupment.  
  • When the Enrollee no longer meets an eligibility requirement based on a change reported by the enrollee, or a periodic data match initiated by the Connector.

956 CMR 12.07 (eligibility review) 12.10(6) (disenrollment); 12.11(enrollee premiums); Health Connector Policy NG-2, Redeterminations during the Benefit Year, Jan. 2015.