Mass. Gen. Laws ch. 176J, sec. 13 — MA Code / Part I / Title XXII / Chapter 176J / Section 13
Filing of health benefit plan proposals for consideration upon request of group purchasing cooperative
Status: in_force

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 combined total of at least 5,000 eligible individuals, eligible employees and eligible dependents who are enrolled in health benefit plans sold, issued, delivered, made effective or renewed to qualified small businesses or eligible individuals shall be annually required to file a plan with each group purchasing cooperative for its consideration if a group purchasing cooperative requests such health plan proposals for its next plan year. (b) Health benefit plans offered by carriers to group purchasing cooperatives shall: (i) include all state-mandated benefits; (ii) apply open enrollment periods for individuals in the same manner as the carrier applies them for individuals outside the group purchasing cooperative, provided, however, that small business group purchasing cooperatives shall establish rules and open enrollment periods for qualified association members to enter or exit group purchasing cooperatives; (iii) apply continuation of coverage provisions in the same manner as the carrier applies those provisions to small group products offered outside the group purchasing cooperative; (iv) apply managed care practices in the same manner as the carrier applies those practices to small group products offered outside the group purchasing cooperative; and (v) apply rating rules, including rating bands, rating factors and the value of rating factors, in the same manner as the carrier applies those rules to small group products offered outside the group purchasing cooperative. (c) Carriers shall comply with a group purchasing cooperative's wellness program's data processing systems to provide information that will enable the group purchasing cooperative to effectively provide guidance to members on targeted wellness programs. (d) Notwithstanding this chapter or any other general or special law to the contrary, carriers may annually offer group purchasing cooperative members rewards or other incentives for participation in wellness programs sponsored by the cooperative. The amount of such rewards shall be determined by the carrier in coordination with the provider of the wellness program, based upon the promotion and participation of the cooperative and its members in sponsored wellness programs that include, among other things, health care education and the use of available transparency tools. Any reward established pursuant to this subsection shall be submitted to the commissioner for informational purposes prior to the payment of any such reward. The requirements to qualify for such reward shall be applied equally and consistently to all cooperative members, treating all similarly situated cooperative members that have qualified for the reward in the same manner. The commissioner shall study the ability of cooperatives to use other incentives for wellness programs within the restrictions of state and federal rating rules and may also consider the use of an innovation waiver to pursue such flexibility.

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 combined total of at least 5,000 eligible individuals, eligible employees and eligible dependents who are enrolled in health benefit plans sold, issued, delivered, made effective or renewed to qualified small businesses or eligible individuals shall be annually required to file a plan with each group purchasing cooperative for its consideration if a group purchasing cooperative requests such health plan proposals for its next plan year.

(b) Health benefit plans offered by carriers to group purchasing cooperatives shall: (i) include all state-mandated benefits; (ii) apply open enrollment periods for individuals in the same manner as the carrier applies them for individuals outside the group purchasing cooperative, provided, however, that small business group purchasing cooperatives shall establish rules and open enrollment periods for qualified association members to enter or exit group purchasing cooperatives; (iii) apply continuation of coverage provisions in the same manner as the carrier applies those provisions to small group products offered outside the group purchasing cooperative; (iv) apply managed care practices in the same manner as the carrier applies those practices to small group products offered outside the group purchasing cooperative; and (v) apply rating rules, including rating bands, rating factors and the value of rating factors, in the same manner as the carrier applies those rules to small group products offered outside the group purchasing cooperative.

(c) Carriers shall comply with a group purchasing cooperative's wellness program's data processing systems to provide information that will enable the group purchasing cooperative to effectively provide guidance to members on targeted wellness programs.

(d) Notwithstanding this chapter or any other general or special law to the contrary, carriers may annually offer group purchasing cooperative members rewards or other incentives for participation in wellness programs sponsored by the cooperative. The amount of such rewards shall be determined by the carrier in coordination with the provider of the wellness program, based upon the promotion and participation of the cooperative and its members in sponsored wellness programs that include, among other things, health care education and the use of available transparency tools. Any reward established pursuant to this subsection shall be submitted to the commissioner for informational purposes prior to the payment of any such reward. The requirements to qualify for such reward shall be applied equally and consistently to all cooperative members, treating all similarly situated cooperative members that have qualified for the reward in the same manner.

The commissioner shall study the ability of cooperatives to use other incentives for wellness programs within the restrictions of state and federal rating rules and may also consider the use of an innovation waiver to pursue such flexibility.