Applicant and Member Responsibility

(1) Applicants and Members, or their authorized representatives, must provide the Plan with the information necessary to establish or maintain enrollment. (2) A Member or his or her authorized representative must report in writing to the Plan within 15 Business Days any changes that may affect eligibility or a Membership Category determination. These changes include, but are not limited to, changes in residence, marital status, disability status, Medicare eligibility, eligibility for the Low-income Subsidy, income, Prescription Drug coverage, and MassHealth coverage, including CommonHealth. (3) If the Plan determines that a Member may qualify for the Low-income Subsidy, the Member must apply for that subsidy and provide the Plan with any documentation the Plan may reasonably request to verify the application. (4) Beginning January 1, 2006, a Member who receives the Low-income Subsidy, must annually re-apply for that subsidy as required by the Social Security Administration, and must provide the Plan with any documentation the Plan may reasonably request to verify the reapplication. (5) If the Member's file is selected for audit and/or review, he or she must cooperate with the Plan to carry out the purpose of the audit and/or review. (6) Failure of an Applicant or Member to fulfill any of their responsibilities set forth in 651 CMR 15.11 may result in the denial or termination of enrollment, or, for Applicants or Members who may be eligible for the Low-income Subsidy but fail to notify the Plan that they have applied for it, classification in a Membership Category that offers no supplemental assistance for premiums, and the lowest supplemental assistance for Co-payments and Deductibles.