When a State imposes premiums, enrollment fees, or similar fees on enrollees, the State plan must describe—
(a)
The amount of the premium, enrollment fee or similar fee imposed on enrollees;
(b)
The time period for which the charge is imposed;
(c)
The group or groups that are subject to the premiums, enrollment fees, or similar charges;
(d)
The consequences for an enrollee or applicant who does not pay a charge, and the disenrollment protections adopted by the State in accordance with § 457.570; and
(e)
The methodology used to ensure that total cost-sharing liability for a family does not exceed the cumulative cost-sharing maximum specified in § 457.560.