26. What happens if a person cannot afford the premiums in ConnectorCare?
After an eligibility determination, a person who will be charged a premium cannot enroll until paying the premium or obtaining a hardship waiver in advance of the first month of enrollment. Enrollment will take place only after the premium is paid or the premium waiver is granted. The first month’s premium is the “binder” premium and it must be received (or waived) to “effectuate” enrollment.
After initial enrollment, members will receive an invoice early in the month with a due date by the 23rd of the month for coverage in the following month. The Connector does not currently accept credit card payments, but does accept electronic fund transfers. See, https://www.mahealthconnector.org/how-to-pay
If a payment is missed by the due date, the enrollee receives an initial delinquency notice. If a second payment is missed by the due date, the enrollee will be notified that if payment is not received in full by the “delinquency payment date” which must be no less than 35 days from the second delinquency notice, coverage will be terminated. If the delinquency payment date is missed, the Connector sends a termination notice retroactive to the last day of the first unpaid month (30 day grace period).
Example: Payment missed Mar 23, 1st delinquency notice in early April. Payment missed April 23, 2d delinquency notice in early May and warning of termination if not paid in full by “delinquency payment due date” in June (must be at least 35 days from May notice). Payment not made in full by delinquency payment date. June notice of termination for nonpayment of premiums retroactive to April 30. Payment for four months’ premiums will be required to reinstate coverage (past due amounts for coverage in April, May and June and advance payment for July).
An enrollee terminated for non-payment may reinstate coverage within 35 days of the termination notice if all outstanding premiums are paid along with the next month’s premium. The termination notice will include reinstatement information including the date by which the Health Connector must receive the request and full payment.
If the individual fell behind because of a decrease in income, or increase in family size (or other change in circumstance that may affect eligibility), he or she should notify the Connector so that a new determination can be made that may reduce or eliminate future premium contributions.
If the premium is due but the individual is experiencing an extreme financial hardship, he or she can request a waiver of premium payments for the duration of the hardship situation for up to 11 months at a time. The Health Connector has a request form for this purpose that can be obtained by calling Customer Assistance. The Connector may waive or reduce the amount of future premium contributions or arrears. The following circumstances are considered hardships if the enrollee:
- is homeless, more than 30 days behind in housing payments or has received eviction or foreclosure notices within the last 60 days;
- has a current shut-off notice or service refusal for an essential utility within the last 60 days;
- has incurred significant unexpected increase in essential expenses in the last six months due to domestic violence, death of a spouse, family member or partner with primary child care responsibility, major illness of a child requiring a working parent to hire a full time child care worker or other natural or human-caused event causing substantial household or personal damage or
- has filed for bankruptcy within the last 12 month and debts are not yet discharged.
Approval of a premium hardship waiver or expiration of a waiver gives rise to a 60 day SEP to change plans.
A member may withdraw from ConnectorCare but remains liable for any premium up to and including the month in which he or she notifies the Connector of withdrawal.
956 C.M.R. § 12.11(Enrollee Premium Contributions); Health Connector Policy #NG-6B, Termination of Coverage-Non-Payments of Premium, 3/1/2019