General Laws of Massachusetts - Chapter 176G Health Maintenance Organizations
- Massachusetts General Laws - Definitions - Chapter 176G, Section 1
The following words as used in this chapter shall, unless the context clearly requires otherwise, have the following meanings: “Affiliate”, an affiliate of, or person...
- Massachusetts General Laws - Application of laws - Chapter 176G, Section 2
Except as hereinafter provided in this chapter, the provisions of chapters one hundred and seventy-five, one hundred and seventy-six A, one hundred and seventy-six B,...
- Massachusetts General Laws - Organization; accounting; contracts - Chapter 176G, Section 3
A carrier or any two or more such companies, corporations, or their subsidiaries or affiliates may: (1) organize and operate a health maintenance organization as...
- Massachusetts General Laws - Required coverage for certain conditions and groups - Chapter 176G, Section 4
A health maintenance contract shall provide coverage for: (a) pregnant women, infants and children as set forth in section 47C of chapter 175; (b) cardiac...
- Massachusetts General Laws - Employees terminated due to plant closings; coverage - Chapter 176G, Section 4A
Any health maintenance contract shall provide coverage for employees terminated due to a plant closing or covered partial closing as required by the second paragraph...
- Massachusetts General Laws - Confidentiality of information; mental or nervous condition; exceptions - Chapter 176G, Section 4B
No health maintenance organization shall require as a condition to receiving benefits pursuant to this chapter consent to the disclosure of information regarding services for...
- Massachusetts General Laws - Home care benefits - Chapter 176G, Section 4C
Any group health maintenance contract shall provide coverage for home care services as set forth in clause (k) of section one hundred and ten of...
- Massachusetts General Laws - Nonprescription enteral formulas for home use - Chapter 176G, Section 4D
A group health maintenance contract shall provide coverage for nonprescription enteral formulas for home use for which a physician has issued a written order and...
- Massachusetts General Laws - Off-label drug use; cancer treatment - Chapter 176G, Section 4E
A group health maintenance contract shall provide coverage for off-label uses of prescription drugs used in the treatment of cancer as set forth in sections...
- Massachusetts General Laws - Group health maintenance contracts; coverage for bone marrow transplants - Chapter 176G, Section 4F
Any group health maintenance contract shall provide coverage for a bone marrow transplant or transplants for persons who have been diagnosed with breast cancer that...
- Massachusetts General Laws - Off-label use of prescription drugs for HIV/AIDS treatment - Chapter 176G, Section 4G
Any individual or group health insurance maintenance contract which provides coverage for prescription drugs shall provide coverage for off-label uses of prescription drugs used in...
- Massachusetts General Laws - Items medically necessary for diagnosis and treatment of diabetes - Chapter 176G, Section 4H
Any individual or group health maintenance contract, except contracts providing supplemental coverage to Medicare or other governmental programs, delivered, issued or renewed by agreement between...
- Massachusetts General Laws - Prenatal, childbirth and postpartum care benefits; minimum coverage for in-patient care - Chapter 176G, Section 4I
Any health maintenance contract shall provide coverage for prenatal care, childbirth and postpartum care in accordance with section four of chapter one hundred and seventy-six...
- Massachusetts General Laws - Scalp hair prostheses necessary due to cancer or leukemia treatment - Chapter 176G, Section 4J
(a) For the purposes of this section, the following words shall have the following meanings: “Prosthesis”, an artificial appliance used to replace a lost natural...
- Massachusetts General Laws - Newborn hearing screening tests - Chapter 176G, Section 4K
A health maintenance contract shall provide coverage for a newborn hearing screening test to be performed before the newborn infant is discharged from the hospital...
- Massachusetts General Laws - Coverage for hospice services - Chapter 176G, Section 4L
Any group health maintenance contract shall provide coverage for hospice services as defined in section 57D of chapter 111 during the life of the patient,...
- Massachusetts General Laws - Mental health benefits; biologically-based mental disorders; rape-related mental disorders; non-biologically-based mental disorders of children and adolescents under age 19 - Chapter 176G, Section 4M
(a) A health maintenance contract issued or renewed within or without the commonwealth shall provide mental health benefits on a nondiscriminatory basis to residents of...
- Massachusetts General Laws - Coverage for speech, hearing and language disorders; hearing aids - Chapter 176G, Section 4N
Any individual or group health maintenance contract that provides hospital expense and surgical expense insurance, delivered, issued or renewed by agreement between the insurer and...
- Massachusetts General Laws - Outpatient services; hormone replacement therapy for peri and post menopausal women; contraceptive services; approved prescription contraceptive drugs or devices; exception - Chapter 176G, Section 4O
(a) Any individual or group health maintenance contract that is issued, renewed or delivered within or without the commonwealth and that provides benefits for outpatient...
- Massachusetts General Laws - Patient care services provided pursuant to qualified clinical trials - Chapter 176G, Section 4P
Any individual or group health maintenance contract shall provide for the coverage of patient care services furnished pursuant to qualified clinical trials as defined in,...
- Massachusetts General Laws - Coverage for human leukocyte or histocompatibility locus antigen testing - Chapter 176G, Section 4Q
Any group health maintenance contract, except contracts providing supplemental coverage to Medicare or to other government programs, delivered, issued or renewed by agreement within or...
- Massachusetts General Laws - Repealed, 2008, 451, Sec. 140 - Chapter 176G, Section 4R
Repealed, 2008, 451, Sec.
- Massachusetts General Laws - Coverage for prosthetic devices and repairs - Chapter 176G, Section 4S
(a) Individual and group health maintenance contracts shall provide coverage for prosthetic devices and repairs. If prosthetic devices are covered as a durable medical equipment...
- Massachusetts General Laws - Coverage for persons under age 26 or for 2 years after end of calendar year in which persons last qualified as dependents - Chapter 176G, Section 4T
[ Text of section effective until January 1, 2014. For text effective January 1, 2014, see below.]A health maintenance contract, excluding contracts for stand-alone dental...
- Massachusetts General Laws - Coverage for medically necessary hypodermic syringes or needles - Chapter 176G, Section 4U
No individual or group health maintenance contract shall restrict or discontinue coverage for medically necessary hypodermic syringes or needles, notwithstanding section 27 of chapter 94C....
- Massachusetts General Laws - Coverage for diagnosis and treatment of autism spectrum disorder - Chapter 176G, Section 4V
(a) As used in this section the following words shall, unless the context clearly requires otherwise, have the following meanings:— “Actuary”, a person who is...
- Massachusetts General Laws - Coverage for children under age 18 for cleft lip and cleft palate - Chapter 176G, Section 4W
[Text of section applicable as provided by 2012, 234, Sec. 8.] A health maintenance contract issued or renewed within or without the commonwealth that covers...
- Massachusetts General Laws - Coverage for orally administered anticancer medications - Chapter 176G, Section 4X
[Text of section applicable as provided by 2012, 403, Sec. 6.] Any individual or group health maintenance contract that provides coverage for cancer chemotherapy treatment...
- Massachusetts General Laws - Emergency services provided to members for emergency medical conditions - Chapter 176G, Section 5
(a) As used in this section, the following words shall have the following meanings:- “Attending physician”, the emergency physician or consultant physician who actively treats...
- Massachusetts General Laws - Divorced or separated spouses; coverage - Chapter 176G, Section 5A
(a) In the event of the granting of a judgment absolute of divorce or of separate support to which a member of a group health...
- Massachusetts General Laws - Contracts - Chapter 176G, Section 6
A health maintenance organization may enter into contractual arrangements with any other person or company for the provision, to the health maintenance organization, of health...
- Massachusetts General Laws - Group health maintenance contracts; contribution percentages - Chapter 176G, Section 6A
A health maintenance organization may only enter into a group health maintenance contract with an employer if the group health maintenance contract is offered by...
- Massachusetts General Laws - Repealed, 2000, 141, Sec. 21 - Chapter 176G, Section 7
Repealed, 2000, 141, Sec.
- Massachusetts General Laws - Public dissemination of deceptive or misleading materials - Chapter 176G, Section 8
Public dissemination of any promotional material, evidence of coverage, health maintenance contract or any other statement with respect to a health maintenance organization, which is...
- Massachusetts General Laws - Trade regulation practices; application of law - Chapter 176G, Section 9
The provisions of sections 1 to 14K, inclusive, and sections 48 to 68, inclusive, of chapter ninety-three, and chapter ninety-three A shall be applicable to...
- Massachusetts General Laws - Reports; audits, examinations or inspections; confidentiality - Chapter 176G, Section 10
Every health maintenance organization shall annually file with the commissioner, within 60 days of the close of its fiscal year, a report verified by at...
- Massachusetts General Laws - Contracts with group insurance commission or local governments - Chapter 176G, Section 11
Every health maintenance organization entering into a contract with the group insurance commission under chapter thirty-two A, or a county, city, town, or district under...
- Massachusetts General Laws - Alternative dental coverage option - Chapter 176G, Section 11A
Each employer or other organization which employs or has twenty-five or more employees or members during the full preceding calendar year and which contracts with...
- Massachusetts General Laws - Health regulations not limited - Chapter 176G, Section 12
Nothing in this chapter shall exempt any person from any applicable provisions of chapters one hundred and eleven or one hundred and twelve, including but...
- Massachusetts General Laws - Name restriction - Chapter 176G, Section 13
No company, person, entity or health care plan not meeting the definition of health maintenance organization specified under this chapter shall use in its name,...
- Massachusetts General Laws - Licensure applicants; documents required; approval by commissioner - Chapter 176G, Section 14
Each applicant for a health maintenance organization license shall upon initial application submit to the commissioner for his approval such materials as the commissioner shall...
- Massachusetts General Laws - Bond; waiver - Chapter 176G, Section 15
Each health maintenance organization shall furnish to the commissioner evidence of a surety bond in an amount satisfactory to the commissioner or deposit with the...
- Massachusetts General Laws - Contracts, rates, evidence of coverage; disapproval of commissioner - Chapter 176G, Section 16
The subscriber contracts, rates and evidence of coverage shall be subject to the disapproval of the commissioner. No such contracts shall be approved if the...
- Massachusetts General Laws - Disapproval of certain health maintenance contracts based on high deductibles - Chapter 176G, Section 16A
The commissioner shall not disapprove a health maintenance contract: (i) if it complies with the requirements of 42 U.S.C. Sec. 18022(e); or (ii) on the...
- Massachusetts General Laws - Disapproval of certain health maintenance contracts for coverage of young adults - Chapter 176G, Section 16B
The commissioner shall not disapprove a health maintenance contract offered as coverage for young adults if the health maintenance contract complies with the minimum standards...
- Massachusetts General Laws - Rules and regulations; standardized claim form - Chapter 176G, Section 17
The commissioner may promulgate rules and regulations as are necessary to carry out the provisions of this chapter including but not limited to the licensing...
- Massachusetts General Laws - Open enrollment for nongroup medicare beneficiaries; period, notice of termination - Chapter 176G, Section 17A
All health maintenance organizations governed by this chapter which enroll medicare beneficiaries shall provide open enrollment for nongroup medicare beneficiaries commencing on February first and...
- Massachusetts General Laws - Repealed, 1993, 110, Sec. 214 - Chapter 176G, Section 18
Repealed, 1993, 110, Sec.
- Massachusetts General Laws - Discrimination against abuse victims in terms of health maintenance contract - Chapter 176G, Section 19
No health maintenance organization subject to this chapter, and no officer or agent thereof, shall cancel, refuse to issue or renew, or in any way...
- Massachusetts General Laws - Insolvent health maintenance organization; administrative supervision, rehabilitation or liquidation; priority of claims - Chapter 176G, Section 20
Any administrative supervision, rehabilitation or liquidation of a health maintenance organization shall be deemed to be the administrative supervision, rehabilitation or liquidation of an insurance...
- Massachusetts General Laws - Administrative supervision, rehabilitation or liquidation of health maintenance organizations; revocation or suspension of license - Chapter 176G, Section 20A
If the commissioner is satisfied, upon examination or other evidence submitted to him, that (1) any health maintenance organization is insolvent or is in an...
- Massachusetts General Laws - Participating provider; contracts with health maintenance organizations; hold harmless clause; limitation on collection actions - Chapter 176G, Section 21
(a) For purposes of this section, “participating provider” shall mean any physician, hospital or other person who, under an express or implied contract with the...
- Massachusetts General Laws - Health care providers; liability of member of health maintenance organization; limitation on collection of amounts owed - Chapter 176G, Section 22
(a) For purposes of this section, “health care provider” shall mean any physician, hospital or other person furnishing health services who has provided such services...
- Massachusetts General Laws - Insolvency of health maintenance organization; replacement coverage - Chapter 176G, Section 23
(a) For purposes of this section, the following words shall, unless the context clearly requires otherwise, have the following meanings:- “Carrier”, a health maintenance organization...
- Massachusetts General Laws - Health maintenance contracts; genetic tests; discrimination based on genetic information - Chapter 176G, Section 24
For the purposes of this section the following words shall have the following meanings:— “Genetic information”, any written recorded individually identifiable result of a genetic...
- Massachusetts General Laws - Net worth of health maintenance organization - Chapter 176G, Section 25
(a) The commissioner shall require upon issuance of an initial license under this chapter that a health maintenance organization shall have an initial adjusted net...
- Massachusetts General Laws - Deposit maintained with trustee acceptable to commissioner - Chapter 176G, Section 26
(a) Except as provided in subsections (b) and (d), each health maintenance organization shall maintain a deposit with a trustee acceptable to the commissioner through...
- Massachusetts General Laws - Merger or acquisition of control - Chapter 176G, Section 27
(a) No person other than the health maintenance organization shall make a tender offer for or a request or invitation for tenders of, or enter...
- Massachusetts General Laws - Registration with commissioner - Chapter 176G, Section 28
(a) Every health maintenance organization which may do business in the commonwealth and which is a member of a health maintenance organization holding company system,...
- Massachusetts General Laws - Violations of Secs. 27 to 29; application for order enjoining violations of Secs. 27 to 29; penalties - Chapter 176G, Section 29
(a)(1) Whenever it appears to the commissioner that any health maintenance organization or any director, officer, employee or agent thereof has committed or is about...
- Massachusetts General Laws - Statement for individuals provided with creditable coverage; reporting - Chapter 176G, Section 30
Pursuant to section 8B of chapter 62C, carriers shall provide written statements to residents of the commonwealth for whom creditable coverage is provided and shall...
- Massachusetts General Laws - Attribution of members to a primary care provider - Chapter 176G, Section 31
To the maximum extent possible, every health maintenance organization shall attribute every member to a primary care provider. Members may change their primary care provider,...
- Massachusetts General Laws - Disclosure of patient-level data and contracted prices of individual health care services by carriers to providers - Chapter 176G, Section 32
[Text of section added by 2012, 224, Sec. 173 effective October 1, 2013. See 2012, 224, Sec. 291.] To the extent permissible under applicable state...
Last modified: September 11, 2015