General Laws of Massachusetts - Chapter 176J Small Group Health Insurance
- Massachusetts General Laws - Definitions - Chapter 176J, Section 1
As used in this chapter the following words shall have the following meanings, unless the context clearly requires otherwise:-- "Actuarial opinion'', a signed written statement by...
- Massachusetts General Laws - Application of chapter - Chapter 176J, Section 2
Except as otherwise provided, this chapter applies to all health benefit plans issued, made effective, delivered or renewed to any eligible small business after April...
- Massachusetts General Laws - Health benefit plan premiums for eligible small businesses - Chapter 176J, Section 3
[ Text of section effective until January 1, 2014. For text effective January 1, 2014, see below.](a) Premiums charged to every eligible small business for...
- Massachusetts General Laws - Carriers to make health benefit plans available; renewal of plans - Chapter 176J, Section 4
[ Paragraph (1) of subsection (a) effective until February 15, 2013. For text effective February 15, 2013, see below.](a)(1) Every carrier shall make available to...
- Massachusetts General Laws - Exclusion of eligible employees; preexisting conditions; waiting periods - Chapter 176J, Section 5
[ Text of section effective until January 1, 2014. For text effective January 1, 2014, see below.](a) No policy shall exclude an eligible individual, eligible...
- Massachusetts General Laws - Approval of health insurance policies; eligibility criteria; submission of information; approval of changes to small group product base rates or rating factors - Chapter 176J, Section 6
(a) Notwithstanding any general or special law to the contrary, the commissioner may approve health insurance policies submitted to the division of insurance for the...
- Massachusetts General Laws - Disclosure by carriers - Chapter 176J, Section 7
(a) Every carrier shall make reasonable disclosure to prospective small business insureds, as part of its solicitation and sales material of:— (1) the surcharge, if...
- Massachusetts General Laws - Transitional reinsurance program - Chapter 176J, Section 8
The commissioner may study the implementation of, establish, if warranted, and supervise a transitional reinsurance program pursuant to section 1341 of the federal Affordable Care...
- Massachusetts General Laws - Continuous coverage - Chapter 176J, Section 9
(a) Subject to the limitations set forth in this section, every carrier shall offer continuation coverage under a health benefit plan issued under this chapter...
- Massachusetts General Laws - Young adult health benefit plans; coverage requirements; premiums - Chapter 176J, Section 10
The division of insurance, with the advice and consent of the director of the connector, shall issue regulations to define coverage for young adult health...
- Massachusetts General Laws - Reduced or selective network plans; tiered network plans; smart tiering plans - Chapter 176J, Section 11
(a) A carrier that offers a health benefit plan that: (i) provides or arranges for the delivery of health care services through a closed network...
- Massachusetts General Laws - Continuing coverage for active course of treatment for serious disease begun prior to enrollment in reduced or selective network plan or tiered network plan - Chapter 176J, Section 11A
(a) For an insured member who (1) is receiving an active course of medical treatment from a health care provider for a serious disease, including...
- Massachusetts General Laws - Small business group purchasing cooperatives; regulations governing establishment, oversight and certification - Chapter 176J, Section 12
(a) The commissioner shall promulgate regulations governing the establishment and oversight of small business group purchasing cooperatives. The regulations shall require: (i) that all state-mandated...
- Massachusetts General Laws - Filing of health benefit plan proposals for consideration upon request of group purchasing cooperative - Chapter 176J, Section 13
(a) As a condition of continued offer of small group health, a carrier that, as of the close of a preceding calendar year, has a...
- Massachusetts General Laws - Coverage of medically necessary and covered services otherwise unavailable within carrier’s provider network - Chapter 176J, Section 14
If a medically necessary and covered service is not available to a member within the carrier’s provider network, the carrier shall cover the services out-of-network,...
- Massachusetts General Laws - Display by insurer offering tiered network plan of cost-sharing differences for enrollees in various tiers in promotional and agreement material - Chapter 176J, Section 15
An insurer offering a tiered network plan shall clearly and conspicuously indicate, in all promotional and agreement materials, the cost-sharing differences for enrollees in the...
- Massachusetts General Laws - Attribution of members to a primary care provider - Chapter 176J, Section 16
To the maximum extent possible, carriers shall attribute every member to a primary care provider. Members may change their primary care provider, provided that the...
- Massachusetts General Laws - Disclosure of patient-level data and contracted prices of individual health care services by carriers to providers - Chapter 176J, Section 17
[Text of section added by 2012, 224, Sec. 180 effective October 1, 2013. See 2012, 224, Sec. 292.] To the extent permissible under applicable state...
Last modified: September 11, 2015