Eligibility Review Related to Connector Programs for Non-group Health Plans

(1) The Connector or its designee may review eligibility for Connector Programs for Non-Group Health Plans every 12 months, consistent with 45 CFR 155.335, or more frequently as part of a mid-year redetermination, consistent with 45 CFR 155.330. Eligibility may also be reviewed more frequently as a result of an Eligible Individual’s change in circumstances, or a change in Connector Program eligibility rules. The Connector or its designee updates the case file based on information received as the result of such review. The Connector reviews eligibility: (a) By information matching with other state and federal agencies, Health Carriers, and information sources as set forth in 956 CMR 12.05; (b) Based on information obtained from an Applicant, Eligible Individual, or Enrollee, subject to verification. (2) The Connector determines, as a result of this review, whether: (a) The Eligible Individual continues to be eligible for a Connector Program; or (b) The Eligible Individual's current circumstances require a change in Connector Program eligibility, including a change in ConnectorCare Plan Type or Premium. (3) The Connector or its designee will notify the Eligible Individual if there is a change in Connector Program eligibility or if the individual is no longer eligible for any Connector Program.