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.