Review of Applications for Enrollment Waivers

(1) The review of enrollment waiver requests is not an adjudicatory proceeding. The Office of Patient Protection shall not be required to conduct a hearing or hold a face-to-face meeting with any applicant. (2) The Office of Patient Protection may grant an enrollment waiver to an eligible individual who certifies, under penalty of perjury, that such individual did not intentionally forgo enroll­ ment into coverage that is at least actuarially equivalent to minimum creditable coverage and for which the individual is or was eligible during a period of open enrollment. (3) The Office of Patient Protection may use the following criteria in determining whether to grant an enrollment waiver to an eligible individual. (a) Evidence of extenuating circumstances that prevented an individual from enrolling in a health benefit plan during the previous open enrollment period or during an applicable special enrollment period, including but not limited to lack of accessibility to minimum creditable coverage; (b) The similarity of the circumstances to the qualifying events set forth in regulations or guidance issued by the Division of Insurance, the Health Connector, or applicable federal law including the Patient Protection and Affordable Care Act, Public Law 111-148, and any rules, regulations or guidance issued thereunder, that permit an individual to enroll in a nongroup health benefit plan outside of the open enrollment period. The Office of Patient Protection may confer with the Division of Insurance, the Health Connector, or other state or federal agency in order to make such determination. (c) The credibility of the evidence presented in the enrollment waiver request. (4) The Office of Patient Protection may not use the applicant's current health status as grounds for approval or disapproval of an enrollment waiver request. (5) The Office of Patient Protection shall notify an applicant of its decision in writing within 30 calendar days of receipt of the enrollment waiver request.