60.03 Coverage month75

In general. A month is a coverage month for an individual if: As of the first day of the month, the individual is enrolled in a QHP; The tax filer pays the tax filer's share of the premium for the individual's coverage under the plan for the month by the unextended due date for filing the tax filer's income tax return for that benefit year, the full premium for the month is paid by APTC and the Vermont Premium Reduction, or the amount of the premium paid (including by advance credit payments) for the month is sufficient to avoid termination of the individual’s coverage for that month under one of the scenarios described in paragraph (d) of this subsection; and The individual is not eligible for the full calendar month for MEC other than coverage in the individual market. (b) Certain individuals enrolled during a month. If an individual enrolls in a QHP and the enrollment is effective on the date of the individual’s birth, adoption or placement for adoption or in foster care, or on the effective date of a court order, the individual is treated as enrolled as of the first day of that month for purposes of this subsection. (c) Premiums paid for a tax filer. Premiums another person pays for coverage of the tax filer, tax filer's spouse, or tax dependent are treated as paid by the tax filer. (d) Scenarios for payment sufficient to avoid coverage termination. The scenarios under which the amount of the premium paid (including by advance credit payments) for the month is sufficient to avoid termination of an individual’s coverage for that month under paragraph (a)(2) of this subsection are the following: The first month of a 3-month grace period required for individuals who, when first failing to timely pay premiums, are receiving APTC.76 A month for which a premium payment threshold has been met and for which month the issuer of the individual’s QHP provides coverage. A month for which the State of Vermont has, during a declared emergency, issued an order prohibiting the issuer of the individual’s QHP from terminating the individual’s coverage for the month irrespective of the whether the full premium for the month is paid. (e) Appeals of coverage eligibility. A tax filer who is eligible for APTC pursuant to an eligibility appeal decision for 75 26 CFR § 1.36B-3(c). 76 45 CFR § 156.270(d). Eligibility-and-Enrollment Procedures Part 7 – Page 33 (Sec.60.00, Sub.60.04) coverage of a member of the tax filer’s coverage family who, based on the appeal decision, retroactively enrolls in a QHP is considered to have met the requirement in (a)(2) of this subsection for a month if the tax filer pays the tax filer’s share of the premiums for coverage under the plan for the month on or before the 120th day following the date of the appeal decision. (f) Examples.77