Mass. Gen. Laws ch. 176K, sec. 4 — MA Code / Part I / Title XXII / Chapter 176K / Section 4
Regulations; prescription drug coverage; compliance with benefit designs
Status: in_force

Section 4. (a) The commissioner shall, to the extent permitted by OBRA 90, promulgate by regulation the plans for medicare supplement insurance and medicare select insurance, and the benefits for those plans, which may be offered, sold, issued, or delivered, or renewed by a carrier on or after a date set by the commissioner by regulation. (b) Any policy issued pursuant to a risk or cost contract shall comply with the requirements of chapter one hundred and seventy-six G and any regulations promulgated thereunder, provided however, that each policy issued pursuant to a risk or cost contract that includes prescription drug coverage shall meet or exceed minimum standards determined by the commissioner pursuant to regulation, and provided further, that the minimum prescription drug coverage shall be comparable to that required in plans for medicare supplement insurance and medicare select insurance. On or after a date established by the commissioner by regulation pursuant to this chapter, no carrier may offer, sell, issue, or deliver any policy for medicare supplement insurance or medicare select insurance or a policy issued pursuant to a risk or cost contract unless it complies with the benefit designs set forth in the commissioner's regulations. The provisions of this section shall also apply to all policies for medicare supplement insurance or medicare select insurance or to any policy issued pursuant to a risk or cost contract renewed by any carrier during and after the third calendar quarter of nineteen hundred and ninety-four. Except as authorized by this chapter, as of the end of the third calendar quarter of nineteen hundred and ninety-four, all policies for medicare supplement insurance or medicare select insurance or policies issued pursuant to a risk or cost contract in force in the commonwealth shall comply with the requirements of this chapter. The commissioner shall promulgate regulations to implement and enforce this section. (c) Any carrier that participates in the market must offer at least one product with prescription drug coverage for each license under which that carrier is participating in the market, provided, however, that a carrier may be granted an exemption from this requirement by the commissioner in order to comply with the provisions of OBRA 90, or with the provisions of law governing contracts; provided that not less than forty-five days prior to the proposed granting of such an exemption, the commissioner shall file with the clerk of the house of representatives and the clerk of the senate documentation explaining the reasons why said exemption is necessary and, if applicable, communication from the health care finance administration relative to prescription drug coverage and the terms of the waiver granted pursuant to the provisions of OBRA 90. Consistent with the implementation of Medicare Part D, no carrier that participates in the market shall offer any Medicare supplement insurance plans with prescription drug coverage. All Medicare supplement insurance plans with prescription drug coverage shall be closed to new enrollments, but shall be kept guaranteed renewable. A person enrolled in a Medicare supplement insurance plan with prescription drug coverage and who enrolls in Medicare Part D shall be transferred to that person's carrier's most comparable Medicare supplement insurance plan without prescription drug coverage, unless that person chooses coverage under any of that carrier's other Medicare supplement insurance plans without prescription drug coverage. The coverage provided by such comparable plan shall become effective when the Medicare Part D coverage becomes effective. The rate for such comparable plan shall be the same rate that is in effect at the time of the transfer. The carrier shall notify all persons affected by this change and shall describe to those persons all the reasons for the respective coverage and rate changes.

Section 4. (a) The commissioner shall, to the extent permitted by OBRA 90, promulgate by regulation the plans for medicare supplement insurance and medicare select insurance, and the benefits for those plans, which may be offered, sold, issued, or delivered, or renewed by a carrier on or after a date set by the commissioner by regulation.

(b) Any policy issued pursuant to a risk or cost contract shall comply with the requirements of chapter one hundred and seventy-six G and any regulations promulgated thereunder, provided however, that each policy issued pursuant to a risk or cost contract that includes prescription drug coverage shall meet or exceed minimum standards determined by the commissioner pursuant to regulation, and provided further, that the minimum prescription drug coverage shall be comparable to that required in plans for medicare supplement insurance and medicare select insurance.

On or after a date established by the commissioner by regulation pursuant to this chapter, no carrier may offer, sell, issue, or deliver any policy for medicare supplement insurance or medicare select insurance or a policy issued pursuant to a risk or cost contract unless it complies with the benefit designs set forth in the commissioner's regulations. The provisions of this section shall also apply to all policies for medicare supplement insurance or medicare select insurance or to any policy issued pursuant to a risk or cost contract renewed by any carrier during and after the third calendar quarter of nineteen hundred and ninety-four. Except as authorized by this chapter, as of the end of the third calendar quarter of nineteen hundred and ninety-four, all policies for medicare supplement insurance or medicare select insurance or policies issued pursuant to a risk or cost contract in force in the commonwealth shall comply with the requirements of this chapter. The commissioner shall promulgate regulations to implement and enforce this section.

(c) Any carrier that participates in the market must offer at least one product with prescription drug coverage for each license under which that carrier is participating in the market, provided, however, that a carrier may be granted an exemption from this requirement by the commissioner in order to comply with the provisions of OBRA 90, or with the provisions of law governing contracts; provided that not less than forty-five days prior to the proposed granting of such an exemption, the commissioner shall file with the clerk of the house of representatives and the clerk of the senate documentation explaining the reasons why said exemption is necessary and, if applicable, communication from the health care finance administration relative to prescription drug coverage and the terms of the waiver granted pursuant to the provisions of OBRA 90.

Consistent with the implementation of Medicare Part D, no carrier that participates in the market shall offer any Medicare supplement insurance plans with prescription drug coverage. All Medicare supplement insurance plans with prescription drug coverage shall be closed to new enrollments, but shall be kept guaranteed renewable. A person enrolled in a Medicare supplement insurance plan with prescription drug coverage and who enrolls in Medicare Part D shall be transferred to that person's carrier's most comparable Medicare supplement insurance plan without prescription drug coverage, unless that person chooses coverage under any of that carrier's other Medicare supplement insurance plans without prescription drug coverage. The coverage provided by such comparable plan shall become effective when the Medicare Part D coverage becomes effective. The rate for such comparable plan shall be the same rate that is in effect at the time of the transfer. The carrier shall notify all persons affected by this change and shall describe to those persons all the reasons for the respective coverage and rate changes.