reglab/housing_qa huggingface dataset:
MA Gen L ch 176b § 4y (2021)
2021 Massachusetts General Laws|Part I - Administration of the Government|Title XXII - Corporations|Chapter 176b - Medical Service Corporations|Section 4y - Coverage for Speech, Hearing and Language Disorders

Section 4Y. Any subscription certificate under an individual or group medical service agreement which provides hospital expense and surgical expense insurance, delivered, issued or renewed by agreement between the insurer and the policyholder, within or without the commonwealth, shall provide benefits for residents of the commonwealth and to all group members having a principal place of employment within the commonwealth for the expenses incurred in the medically necessary diagnosis and treatment of speech, hearing and language disorders by individuals licensed as speech–language pathologists or audiologists under chapter 112, if such services are rendered within the lawful scope of practice for such speech–language pathologists or audiologists regardless of whether the services are provided in a hospital, clinic or private office; provided, however, that such coverage shall not extend to the diagnosis or treatment of speech, hearing and language disorders in a school–based setting. The benefits provided by this section shall be subject to the same terms and conditions established for any other medical condition covered by such individual or group medical service agreement.
MA Gen L ch 176b § 4aa (2021)
2021 Massachusetts General Laws|Part I - Administration of the Government|Title XXII - Corporations|Chapter 176b - Medical Service Corporations|Section 4aa - Coverage for Prosthetic Devices and Repairs

Section 4AA. (a) Any subscription certificate under an individual or group medical service agreement, except certificates which provide supplemental coverage to Medicare or other governmental programs that shall be delivered, issued or renewed within the commonwealth shall provide, as benefits to all individual subscribers or members within the commonwealth and to all group members having a principal place of employment within the commonwealth, coverage for prosthetic devices and repairs. If prosthetic devices are covered as a durable medical equipment benefit, coverage shall be provided under the same terms and conditions that apply to other durable medical equipment covered under the policy, except as otherwise provided in this section. If prosthetic devices are covered as a stand-alone prosthetic benefit, coverage shall be consistent with the terms and conditions as described in this section.  (b) In this section, ''prosthetic device'' shall mean an artificial limb device to replace, in whole or in part, an arm or leg.  (c) No such certificate shall impose any annual or lifetime dollar maximum on coverage for prosthetic devices other than an annual or lifetime dollar maximum that applies in the aggregate to all items and services covered under the certificate.  (d) No such certificate shall apply amounts paid for prosthetic devices to any annual or lifetime dollar maximum applicable to other durable medical equipment covered under the certificate other than an annual or lifetime dollar maximum that applies in the aggregate to all items and services covered under the certificate.  (e) Any such certificate may include a reasonable coinsurance requirement for prosthetic devices and repairs, not to exceed 20 per cent of the allowable cost of the prosthetic device or repair, unless all covered benefits applying coinsurance under the plan do so at a higher amount. If the certificate provides coverage for services from nonparticipating providers, the contract may include a reasonable coinsurance requirement for prosthetic devices and repairs, not to exceed 40 per cent of the allowable cost of the prosthetic device or repair when obtained from a nonparticipating provider, unless all covered benefits applying coinsurance under the plan do so at a higher amount.  (f) Any such certificate may require prior authorization as a condition of coverage for prosthetic devices.  (g) Any such contract shall only be required to provide coverage for the most appropriate medically necessary model that adequately meets the medical needs of the policyholder.
MA Gen L ch 176b § 4bb (2021)
2021 Massachusetts General Laws|Part I - Administration of the Government|Title XXII - Corporations|Chapter 176b - Medical Service Corporations|Section 4bb - Coverage for Eligible Dependents Under 26 Years of Age

Section 4BB. Any subscription certificate under an individual or group medical service agreement, except certificates that provide stand-alone dental services, supplemental coverage to Medicare or other governmental programs, that is delivered or issued or renewed in the commonwealth, shall provide, as benefits to all individual subscribers and members within the commonwealth and to all group members having a principal place of employment within the commonwealth, coverage to eligible dependents under 26 years of age.
MA Gen L ch 176b § 4cc (2021)
2021 Massachusetts General Laws|Part I - Administration of the Government|Title XXII - Corporations|Chapter 176b - Medical Service Corporations|Section 4cc - Coverage for Medically Necessary Hypodermic Syringes or Needles

Section 4CC. No subscription certificate under an individual or group medical service agreement, delivered, issued or renewed in the commonwealth shall restrict or discontinue coverage for medically necessary hypodermic syringes or needles to an individual or group subscriber within the commonwealth or to a group subscriber having a principal place of employment within the commonwealth, notwithstanding section 27 of chapter 94C. The term ''medical necessity'' shall be construed in accordance with the guidelines set forth in subsection (b) of section 16 of chapter 176O.
MA Gen L ch 176b § 4ff (2021)
2021 Massachusetts General Laws|Part I - Administration of the Government|Title XXII - Corporations|Chapter 176b - Medical Service Corporations|Section 4ff - Coverage for Orally Administered Anticancer Medications

Section 4FF. Any subscription certificate under an individual or group medical service agreement delivered, issued or renewed within the commonwealth that provides coverage for cancer chemotherapy treatment shall provide coverage for prescribed, orally administered anticancer medications used to kill or slow the growth of cancerous cells on a basis not less favorable than intravenously administered or injected cancer medications that are covered as medical benefits. An increase in patient cost sharing for anticancer medications shall not be allowed to achieve compliance with this section.
MA Gen L ch 176b § 4gg (2021)
2021 Massachusetts General Laws|Part I - Administration of the Government|Title XXII - Corporations|Chapter 176b - Medical Service Corporations|Section 4gg - Coverage for Abuse Deterrent Opioid Drug Products

Section 4GG. Any subscription certificate under an individual or group medical service agreement delivered, issued or renewed within the commonwealth shall provide coverage for abuse deterrent opioid drug products listed on the formulary, compiled pursuant to subsection (b) of section 13 of chapter 17, on a basis not less favorable than non-abuse deterrent opioid drug products that are covered by an individual or group medical service agreement. An increase in patient cost sharing shall not be allowed to achieve compliance with this section.
MA Gen L ch 176b § 4hh (2021)
2021 Massachusetts General Laws|Part I - Administration of the Government|Title XXII - Corporations|Chapter 176b - Medical Service Corporations|Section 4hh - Preauthorization for Substance Abuse Treatment Not to Be Required

Section 4HH. For the purposes of this section the term ''substance abuse treatment'' shall include: early intervention services for substance use disorder treatment; a substance use disorder evaluation, as defined in section 51.5 of chapter 111; outpatient services including medically assisted therapies; intensive outpatient and partial hospitalization services; residential or inpatient services, not covered under section 4II; and medically managed intensive inpatient services, not covered under said section 4II.  Any subscription certificate under an individual or group medical service agreement delivered, issued or renewed within the commonwealth shall not require a member to obtain a preauthorization for substance abuse treatment if the provider is certified or licensed by the department of public health.
MA Gen L ch 176b § 4ii (2021)
2021 Massachusetts General Laws|Part I - Administration of the Government|Title XXII - Corporations|Chapter 176b - Medical Service Corporations|Section 4ii - Coverage for Medically Necessary Acute Treatment or Clinical Stabilization Services

Section 4II. For the purposes of this section the following terms shall, unless the context clearly requires otherwise, have the following meanings:—  ''Acute treatment services'', 24–hour medically supervised addiction treatment for adults or adolescents provided in a medically managed or medically monitored inpatient facility, as defined by the department of public health, that provides evaluation and withdrawal management and which may include biopsychosocial assessment, individual and group counseling, psychoeducational groups and discharge planning.  ''Clinical stabilization services'', 24–hour clinically managed post detoxification treatment for adults or adolescents, as defined by the department of public health, usually following acute treatment services for substance abuse, which may include intensive education and counseling regarding the nature of addiction and its consequences, relapse prevention, outreach to families and significant others and aftercare planning, for individuals beginning to engage in recovery from addiction.  Any subscription certificate under an individual or group medical service agreement delivered, issued or renewed within the commonwealth shall provide coverage for medically necessary acute treatment services and medically necessary clinical stabilization services for up to a total of 14 days and shall not require preauthorization prior to obtaining acute treatment services or clinical stabilization services; provided that the facility shall provide the carrier both notification of admission and the initial treatment plan within 48 hours of admission; provided further, that utilization review procedures may be initiated on day 7; provided further, any subscription certificate under an individual or group medical service agreement delivered, issued or renewed within the commonwealth shall provide coverage for, without preauthorization, a substance use disorder evaluation ordered pursuant to section 51.5 of chapter 111.  Medical necessity shall be determined by the treating clinician in consultation with the patient and noted in the patient's medical record.
MA Gen L ch 176b § 4jj (2021)
2021 Massachusetts General Laws|Part I - Administration of the Government|Title XXII - Corporations|Chapter 176b - Medical Service Corporations|Section 4jj - Coverage for Long-Term Antibiotic Therapy for Patients With Lyme Disease

[ Text of section added by 2016, 183, Sec. 3 effective until July 1, 2021. Repealed by 2016, 133, Sec. 114. See also, Section 4JJ added by 2016, 454, Sec. 5, below.]  Section 4JJ. (a) For the purposes of this section, "long-term antibiotic therapy'' and "Lyme disease'' shall have the meaning ascribed to them in section 12DD of chapter 112.  (b) A subscription certificate under an individual or group medical service agreement delivered, issued or renewed within the commonwealth shall provide coverage for long-term antibiotic therapy for a patient with Lyme disease when determined to be medically necessary and ordered by a licensed physician after making a thorough evaluation of the patient's symptoms, diagnostic test results or response to treatment. An experimental drug shall be covered as a long-term antibiotic therapy if it is approved for an indication by the United States Food and Drug Administration; provided, however, that a drug, including an experimental drug, shall be covered for an off-label use in the treatment of Lyme disease if the drug has been approved by the United States Food and Drug Administration. Chapter 176B: Section 4JJ. Coverage for refills of prescription eye drops [ Text of section added by 2016, 454, Sec. 5 effective until July 1, 2021. Repealed by 2016, 133, Sec. 114. See also, Section 4JJ added by 2016, 183, Sec. 3, above.]  Section 4JJ. A subscription certificate under an individual or group medical service agreement delivered, issued or renewed within the commonwealth that provides coverage for prescription eye drops shall provide coverage for refills of prescription eye drops in accordance with the Medicare Part D guidelines on early refills of topical ophthalmic products when: (i) the prescribing health care practitioner indicates on the original prescription that additional quantities of the prescription eye drops are needed; (ii) the refill requested by the insured does not exceed the number of additional quantities indicated on the original prescription by the prescribing health care practitioner; and (iii) the prescription eye drops prescribed by the health care practitioner are a covered benefit under the policy or contract of the insured.
MA Gen L ch 176b § 4kk (2021)
2021 Massachusetts General Laws|Part I - Administration of the Government|Title XXII - Corporations|Chapter 176b - Medical Service Corporations|Section 4kk - Coverage for Medical or Drug Treatments to Correct or Repair Disturbances of Body Composition Caused by HIV Associated Lipodystrophy Syndrome

Section 4KK. Any subscription certificate under an individual or group medical service agreement delivered, issued or renewed within the commonwealth shall provide coverage for medical or drug treatments to correct or repair disturbances of body composition caused by HIV associated lipodystrophy syndrome including, but not limited to, reconstructive surgery, such as suction assisted lipectomy, other restorative procedures and dermal injections or fillers for reversal of facial lipoatrophy syndrome. Coverage shall be subject to a statement from a treating provider that the treatment is necessary for correcting, repairing or ameliorating the effects of HIV associated lipodystrophy syndrome. The benefits in this section shall not be subject to any greater deductible, coinsurance, copayments or out-of-pocket limits than any other benefit provided by the insurer.
MA Gen L ch 176b § 4ll (2021)
2021 Massachusetts General Laws|Part I - Administration of the Government|Title XXII - Corporations|Chapter 176b - Medical Service Corporations|Section 4ll - Filling of Remaining Portion of Prescription for Covered Drug That Is a Narcotic Substance Earlier Filled in Lesser Quantity

Section 4LL. Any subscription certificate under an individual or group medical service agreement delivered, issued or renewed within the commonwealth shall provide, for any covered drug that is a narcotic substance contained in schedule II pursuant to chapter 94C and subject to cost sharing, that if a person receives a prescription filled in a lesser quantity pursuant to section 18 of said chapter 94C, said person shall not be subject to an additional payment obligation, including but not limited to co-payments, if said person fills the remaining portion of the prescription.
MA Gen L ch 176b § 4mm (2021)
2021 Massachusetts General Laws|Part I - Administration of the Government|Title XXII - Corporations|Chapter 176b - Medical Service Corporations|Section 4mm - Pain Management Access Plans

Section 4MM. (a) Any subscription certificate under an individual or group medical service agreement delivered, issued or renewed within the commonwealth shall develop a plan to provide adequate coverage and access to a broad spectrum of pain management services, including, but not limited to, those that serve as alternatives to opioid prescribing, in accordance with guidelines developed by the division of insurance.  (b) The plan shall be subject to approval and shall be a component of carrier accreditation by the division of insurance pursuant to section 2 of chapter 176O. In its review, the division shall consider the adequacy of access to a broad spectrum of pain management services and any carrier policies that may create unduly preferential coverage to prescribing opioids without other pain management modalities.  (c) Carriers shall distribute educational materials to providers within their networks about the pain management access plan and make information about their plans publicly available on their websites.
MA Gen L ch 176b § 4nn (2021)
2021 Massachusetts General Laws|Part I - Administration of the Government|Title XXII - Corporations|Chapter 176b - Medical Service Corporations|Section 4nn - Coverage for Tobacco Use Cessation Counseling and Tobacco Cessation Products

Section 4NN. (a) Any subscription certificate under an individual or group medical service agreement delivered, issued or renewed within the commonwealth shall provide coverage for: (i) tobacco use cessation counseling; and (ii) all generic United States Food and Drug Administration-approved tobacco cessation products without cost sharing when prescribed by a health care provider.  (b) Carriers shall be permitted to employ reasonable managed care techniques consistent with state and federal law to determine the frequency, method, treatment or setting for the recommended item or service; provided, however, that covered persons shall have access to at least 1 tobacco cessation product without prior authorization.
MA Gen L ch 176b § 4oo (2021)
2021 Massachusetts General Laws|Part I - Administration of the Government|Title XXII - Corporations|Chapter 176b - Medical Service Corporations|Section 4oo - Coverage for Treatment of Pediatric Autoimmune Neuropsychiatric Disorders Associated With Streptococcal Infections and Pediatric Acute-Onset Neuropsychiatric Syndrome

[Text of section applicable to contracts that take effect or are renewed on or after January 1, 2022. See 2020, 260, Sec. 74.]  Section 4OO. Any subscription certificate under an individual or group medical service agreement delivered, issued or renewed within the commonwealth shall provide coverage for treatment of pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections and pediatric acute-onset neuropsychiatric syndrome including, but not limited to, the use of intravenous immunoglobulin therapy.
MA Gen L ch 176b § 4pp (2021)
2021 Massachusetts General Laws|Part I - Administration of the Government|Title XXII - Corporations|Chapter 176b - Medical Service Corporations|Section 4pp - Coverage for Long-Term Antibiotic Therapy for Lyme Disease; Experimental Drugs

[ Text of section added by 2021, 29, Sec. 24 effective July 1, 2021 until July 1, 2022. See 2021, 29, Sec. 69. Repealed by 2021, 29, Sec. 25.]  Section 4PP. (a) For the purposes of this section, "long-term antibiotic therapy'' and "Lyme disease'' shall have the meaning ascribed to them in section 12DD of chapter 112.  (b) A subscription certificate under an individual or group medical service agreement delivered, issued or renewed within the commonwealth shall provide coverage for long-term antibiotic therapy for a patient with Lyme disease when determined to be medically necessary and ordered by a licensed physician after making a thorough evaluation of the patient's symptoms, diagnostic test results or response to treatment. An experimental drug shall be covered as a long-term antibiotic therapy if it is approved for an indication by the United States Food and Drug Administration; provided, however, that a drug, including an experimental drug, shall be covered for an off-label use in the treatment of Lyme disease if the drug has been approved by the United States Food and Drug Administration.
MA Gen L ch 176b § 4qq (2021)
2021 Massachusetts General Laws|Part I - Administration of the Government|Title XXII - Corporations|Chapter 176b - Medical Service Corporations|Section 4qq - Coverage for Prescription Eye Drops

[ Text of section added by 2021, 29, Sec. 24 effective July 1, 2021. See 2021, 29, Sec. 69.]  Section 4QQ. A subscription certificate under an individual or group medical service agreement delivered, issued or renewed within the commonwealth that provides coverage for prescription eye drops shall provide coverage for refills of prescription eye drops in accordance with the Medicare Part D guidelines on early refills of topical ophthalmic products when: (i) the prescribing health care practitioner indicates on the original prescription that additional quantities of the prescription eye drops are needed; (ii) the refill requested by the insured does not exceed the number of additional quantities indicated on the original prescription by the prescribing health care practitioner; and (iii) the prescription eye drops prescribed by the health care practitioner are a covered benefit under the policy or contract of the insured.
MA Gen L ch 176b § 5 (2021)
2021 Massachusetts General Laws|Part I - Administration of the Government|Title XXII - Corporations|Chapter 176b - Medical Service Corporations|Section 5 - Subscribers; Qualifications, Misrepresentation; Open Enrollment Periods

Section 5. Any person residing in the commonwealth shall have the right to become a subscriber of a medical service corporation if his qualifications meet those specified in the by-laws of such corporation, provided that such a corporation may, in its discretion, refuse to issue a subscription certificate to, or upon due notice cancel the subscription certificate of, any person who has made any fraudulent claim or representation to the corporation or to a participating physician, participating chiropractor or to any other participating provider of health services licensed under the laws of the commonwealth, or has been guilty of uncooperative or unethical dealings with the corporation, or has failed to pay dues and assessments seasonably and promptly or for any other cause which may be approved by the commissioner. Such corporation shall provide for annual open enrollment periods of not less than two months' duration. Proper notification shall be given to prospective subscribers in a form subject to approval by the commissioner.
MA Gen L ch 176b § 5a (2021)
2021 Massachusetts General Laws|Part I - Administration of the Government|Title XXII - Corporations|Chapter 176b - Medical Service Corporations|Section 5a - Discrimination Against Abuse Victims in Terms of Medical Service Plans

Section 5A. No corporation subject to this chapter, and no officer or agent thereof, shall cancel, refuse to issue or renew, or in any way make or permit any distinction or discrimination in the amount or payment of premiums or rates charged, in the length of coverage, or in any other of the terms and conditions of a medical service plan based on information that an individual has been a victim of abuse, as defined by section one of chapter two hundred and nine A. No corporation subject to this chapter, and no officer or agent thereof, shall seek information that such person has been a victim of abuse as defined by said section one of said chapter two hundred and nine A. The practices prohibited under this section shall include not only those overtly discriminatory but also practices and devices which are fair in form but discriminatory in practice. Nothing in this section shall be construed as creating a special class of insureds who have been victims of abuse as defined by said section one of said chapter two hundred and nine A. Any violation of this section shall constitute an unfair method of competition or an unfair or deceptive act or practice in violation of chapters ninety-three A and one hundred and seventy-six D.