reglab/housing_qa huggingface dataset:
MA Gen L ch 176i § 9 (2021)
2021 Massachusetts General Laws|Part I - Administration of the Government|Title XXII - Corporations|Chapter 176i - Preferred Provider Arrangements|Section 9 - Application of Laws

Section 9. An organization which offers or administers a health benefit plan or furnishes workers' compensation, under a preferred provider arrangement shall be subject to all of the provisions of its enabling or licensing statute and of any other provisions of the general laws applicable thereto, including but not limited to, the provisions of chapter 176O and any benefits required to be provided by law. To the extent that this section is inconsistent with the provisions of one hundred and seventy-six M and any regulations promulgated thereunder, any nongroup health plan under a preferred provider arrangement that is within the definition of a guaranteed issue health plan in said chapter one hundred and seventy-six M shall be governed by the provisions of said chapter one hundred and seventy-six M and any regulations promulgated thereunder. In connection with any preferred provider arrangement and activities, an organization shall be considered to be an insurance company for the purposes of sections one hundred and ninety-three C, one hundred and ninety-three D, one hundred and ninety-three L, one hundred and ninety-three M and one hundred and ninety-three N of chapter one hundred and seventy-five.
MA Gen L ch 176i § 10 (2021)
2021 Massachusetts General Laws|Part I - Administration of the Government|Title XXII - Corporations|Chapter 176i - Preferred Provider Arrangements|Section 10 - Applications

Section 10. Any organization which has entered into preferred provider arrangements prior to the effective date of this chapter shall file an application within ninety days of the effective date of this chapter, and may continue to operate until such time as its application may be denied.
MA Gen L ch 176i § 11 (2021)
2021 Massachusetts General Laws|Part I - Administration of the Government|Title XXII - Corporations|Chapter 176i - Preferred Provider Arrangements|Section 11 - Annual Assessment

Section 11. (a) Every organization other than a workers' compensation insurer, operating a preferred provider arrangement shall annually pay an assessment equal to two and twenty-eight hundredths per cent of the gross premiums received during the preceding calendar year for coverage of covered persons residing in this commonwealth; provided, however, that no assessment shall be imposed on premiums for medicare supplemental coverage. In calculating said gross premiums, there shall be deducted any amounts eligible for deduction pursuant to section twenty-four of chapter sixty-three and any amounts that are subject to the assessment imposed by section one hundred and ten L of chapter one hundred and seventy-five or by section ten A of chapter one hundred and seventy-six G. All said assessments, including interest thereon or penalties, shall be deposited in the general fund.  (b) The assessment imposed by this section shall be collected and administered by the commissioner of revenue. Every organization operating a preferred provider arrangement shall annually, on or before March fifteenth, make a return to said commissioner giving such information as said commissioner may deem necessary for the determination of the assessment for the preceding calendar year. The payment and collection of the assessments imposed by this section shall, to the extent consistent with this section, be governed by the provisions of chapters sixty-two C and sixty-three B. This provision shall take effect for premiums received after December thirty-first, nineteen hundred and eighty-eight.
MA Gen L ch 176i § 12 (2021)
2021 Massachusetts General Laws|Part I - Administration of the Government|Title XXII - Corporations|Chapter 176i - Preferred Provider Arrangements|Section 12 - Coverage for Children Under Age 18 for Cleft Lip and Cleft Palate

Section 12. An organization entering into a preferred provider contract that covers a child under the age of 18 shall provide coverage for the cost of treating cleft lip and cleft palate for the child. The coverage shall include benefits for medical, dental, oral and facial surgery, surgical management and follow-up care by oral and plastic surgeons, orthodontic treatment and management, preventative and restorative dentistry to ensure good health and adequate dental structures for orthodontic treatment or prosthetic management therapy, speech therapy, audiology and nutrition services, if such services are prescribed by the treating physician or surgeon and such physician or surgeon certifies that such services are medically necessary and consequent to the treatment of the cleft lip, cleft palate or both. The coverage required by this section shall be subject to the terms and conditions applicable to other benefits. Payment for dental or orthodontic treatment not related to the management of the congenital conditions of cleft lip and cleft palate shall not be covered under this section.
MA Gen L ch 176j § 2 (2021)
2021 Massachusetts General Laws|Part I - Administration of the Government|Title XXII - Corporations|Chapter 176j - Small Group Health Insurance|Section 2 - Application of Chapter

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 1, 1992, and all health benefit plans issued, made effective, delivered or renewed to any eligible individual on or after July 1, 2007, whether issued directly by a carrier, through the connector, or through an intermediary. Nothing in this chapter shall be construed to require a carrier that does not issue health benefit plans subject to the chapter to issue health benefit plans subject to this chapter.
MA Gen L ch 176j § 5 (2021)
2021 Massachusetts General Laws|Part I - Administration of the Government|Title XXII - Corporations|Chapter 176j - Small Group Health Insurance|Section 5 - Exclusion of Eligible Individuals

Section 5. No policy shall exclude an eligible individual, eligible employee or eligible dependent on the basis of age, occupation, actual or expected health condition, claims experience, duration of coverage or medical condition.
MA Gen L ch 176j § 7 (2021)
2021 Massachusetts General Laws|Part I - Administration of the Government|Title XXII - Corporations|Chapter 176j - Small Group Health Insurance|Section 7 - Disclosure by Carriers

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 any, which shall be applied to a group's premium if one or more members are covered in the plan set forth in section 8; and  (2) the participation requirements or participation rate adjustments of the carrier for each health benefit plan.  (b) Every carrier, as a condition of doing business under the jurisdiction of this chapter on and after January 1, 2007, shall electronically file with the commissioner an annual actuarial opinion that the carrier's rating methodologies and rates to be applied in the upcoming calendar year comply with the requirements of this chapter and any regulations promulgated under the authority of this chapter. In addition, every carrier shall file electronically an annual statement of the number of eligible individuals, eligible employees and eligible dependents, as of the close of the preceding calendar year, enrolled in a health benefit plan offered by the carrier. A carrier that may require eligible individuals or eligible small groups with 5 or fewer eligible employees to obtain coverage through an intermediary or the connector shall file a list of those intermediaries, with associated contact information, before requiring those small groups to go through an intermediary to obtain small group health coverage. Every carrier shall maintain at its principal place of business a complete and detailed description of its rating practices including information and documentation which demonstrates that its rating methods and practices are based upon commonly accepted actuarial assumptions, are under sound actuarial principles, and comply with this chapter. Such information shall be made available to the commissioner upon request, but shall remain confidential.  (c) Every carrier shall notify the commissioner regarding any material changes or additions to the actuarial methodology at least 30 days before the effective date of the change or addition, including amendments to rate basis types, rating factors, intermediary relationships, distribution networks and products offered within this market. If the commissioner determines that a carrier is not complying with this chapter, the commissioner may disapprove the rating methodologies and the rates which the carrier uses.
MA Gen L ch 176j § 8 (2021)
2021 Massachusetts General Laws|Part I - Administration of the Government|Title XXII - Corporations|Chapter 176j - Small Group Health Insurance|Section 8 - Transitional Reinsurance Program

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 Act or, if the commissioner believes that such program is not appropriate for the commonwealth, to apply for any appropriate waiver from the requirement to implement such program. The commissioner may promulgate regulations to enforce this section; provided, however, that before a waiver is sought or a transitional reinsurance program is to be implemented, the commissioner shall provide a report on the decision and the details of any proposed program to the clerks of the senate and house of representatives and the senate and house committee on ways and means.
MA Gen L ch 176j § 10 (2021)
2021 Massachusetts General Laws|Part I - Administration of the Government|Title XXII - Corporations|Chapter 176j - Small Group Health Insurance|Section 10 - Young Adult Health Benefit Plans; Coverage Requirements; Premiums

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 benefit plans, and to implement this section. Eligibility for enrollment in a qualifying young adult health insurance program will be restricted to individuals between the ages of 18 and 26, inclusive, who do not otherwise have access to health insurance coverage subsidized by an employer. Coverage for young adults shall provide reasonably comprehensive coverage of inpatient and outpatient hospital services and physician services for physical and mental illness and shall provide all services which a carrier is required to include under applicable division of insurance statutes and regulations, including, but not limited to, mental health services, emergency services, and any health service or category of health service provider which a carrier is required by its licensing or other statute to include in its health benefit plans. Any carrier offering young adult health plans must offer at least 1 product that includes coverage for outpatient prescription drugs. Coverage for young adults may impose reasonable copayments, coinsurance and deductibles and may use cost control techniques commonly used in the health insurance industry, including tiered provider networks and selective provider contracting.  Such plans shall only be offered by a carrier that, as of the close of any preceding calendar year, has a combined total of 5,000 or more eligible individuals, eligible employees and eligible dependents, who are enrolled in health plans sold, issued, delivered, made effective or renewed to qualified small businesses or eligible individuals pursuant to its license under chapter 175, chapter 176A, chapter 176B or chapter 176G. Further, such plans shall only be offered through the commonwealth health insurance connector as defined in chapter 176Q. Premium rates for young adult plans shall be consistent with section 3.
MA Gen L ch 176j § 11a (2021)
2021 Massachusetts General Laws|Part I - Administration of the Government|Title XXII - Corporations|Chapter 176j - Small Group Health Insurance|Section 11a - Continuing Coverage for Active Course of Treatment for Serious Disease Begun Prior to Enrollment in Reduced or Selective Network Plan or Tiered Network Plan

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 but not limited to cancer or cystic fibrosis, that if disrupted in the course of medical treatment would pose an undue hardship to the patient and (2)(i) began this active course of treatment before being enrolled in a reduced or selective network plan where the provider is not part of the reduced or selective network or (ii) began this active course of treatment before being enrolled in a tiered network plan where the provider is in the highest cost-sharing tier, the carrier shall provide coverage for those medically necessary and covered services that are part of that active course of treatment provided by that health care provider, to the extent required by subsection (b).  (b) A carrier to which subsection (a) applies shall cover the health care provider's services for the duration of the active course of treatment during the plan year, if (1) the insured's employer offers the insured only a choice of reduced or selective network plans in which the health care provider is not part of any of the offered reduced or selective networks, or a choice of tiered network plans in which the health care provider is in the highest cost-sharing tier; (2) that health care provider is a comprehensive cancer center, pediatric hospital or pediatric specialty unit as defined in section 1 of chapter 118G; and (3) that health care provider is providing the insured with an active course of medical treatment that is not available from another provider in the network of the insured's plan.  (c) For services provided under this section from a provider that is not in the network of the insured's plan, patient cost-sharing shall be at the lowest cost-sharing level applicable to those services in the plan, and reimbursement shall be based on median in-network rates of the specific health care provider in that carrier's private plans in a manner consistent with data filed by that carrier with the division of health care finance and policy; provided, however, that if the specific health care provider does not participate in any other plan of the carrier, then based on negotiated rates. For services provided under this section by a provider in the highest cost-sharing tier of a tiered network plan, patient cost-sharing shall be based on the second-highest cost-sharing tier in that plan.  (d) The commissioner shall adopt regulations to carry out this section.
MA Gen L ch 176j § 14 (2021)
2021 Massachusetts General Laws|Part I - Administration of the Government|Title XXII - Corporations|Chapter 176j - Small Group Health Insurance|Section 14 - Coverage of Medically Necessary and Covered Services Otherwise Unavailable Within Carrier's Provider Network

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, for as long as the service is unavailable in-network.
MA Gen L ch 176j § 15 (2021)
2021 Massachusetts General Laws|Part I - Administration of the Government|Title XXII - Corporations|Chapter 176j - Small Group Health Insurance|Section 15 - Display by Insurer Offering Tiered Network Plan of Cost-Sharing Differences for Enrollees in Various Tiers in Promotional and Agreement Material

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 various tiers. The commissioner shall adopt regulations to carry out this section.
MA Gen L ch 176j § 16 (2021)
2021 Massachusetts General Laws|Part I - Administration of the Government|Title XXII - Corporations|Chapter 176j - Small Group Health Insurance|Section 16 - Attribution of Members to a Primary Care Provider

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 member gives notice to the carrier.
MA Gen L ch 176j § 17 (2021)
2021 Massachusetts General Laws|Part I - Administration of the Government|Title XXII - Corporations|Chapter 176j - Small Group Health Insurance|Section 17 - Disclosure of Patient-Level Data and Contracted Prices of Individual Health Care Services by Carriers to Providers

Section 17. To the extent permissible under applicable state and federal privacy laws, every carrier shall disclose patient-level data to providers in their network solely for the purpose of carrying out treatment, coordinating care among providers and managing the care of their own patient panel; provided, that an individual provider shall only receive patient-level data related to patients treated by said provider. Patient-level data shall include, but not be limited to, health care service utilization, medical expenses, and demographics.  The division of insurance shall develop procedures and a standard format for disclosing such patient-level information. The division may require carriers to disclose such information through the all-payer claims database established under section 12 of chapter 12C if the division and the center for health information and analysis determine that the all-payer claims database is an efficient means to provide such information.  Carriers shall make available to any provider with whom they have entered into an alternative payment contract, the contracted prices of individual health care services within such payer's network for the purpose of referrals.
MA Gen L ch 176k § 2 (2021)
2021 Massachusetts General Laws|Part I - Administration of the Government|Title XXII - Corporations|Chapter 176k - Medicare Supplement Insurance Plans|Section 2 - Compliance; Withdrawal From Market

Section 2. (a) Notwithstanding the provisions of any other law to the contrary, and subject to the provisions of OBRA 90 and Section 1882 of the federal Social Security Act (42 U.S.C. Section 1395 et seq.), any policy for medicare supplement insurance or medicare select insurance or policy issued pursuant to a risk or cost contract offered, sold, issued, delivered, or otherwise made effective or renewed by a carrier in the commonwealth after July first, nineteen hundred and ninety-four shall comply with the provisions of this chapter.  (b) A carrier that participated in the market on or after a date set by the commissioner by regulation may not withdraw from the market until all insureds of such carrier have had the opportunity to join a policy for medicare supplement insurance or medicare select insurance or a policy issued pursuant to a risk or cost contract offered by another carrier during the next annual open enrollment period or other enrollment period required in section three.  (c) A carrier that withdraws from the market on or after the effective date of this chapter may not participate in the market in the commonwealth for five years from the date of withdrawal, unless the commissioner finds that such re-entry shall be permitted earlier than said five years due to a compelling public interest.
MA Gen L ch 176k § 6 (2021)
2021 Massachusetts General Laws|Part I - Administration of the Government|Title XXII - Corporations|Chapter 176k - Medicare Supplement Insurance Plans|Section 6 - Filing of Policy Form or Certificate Form

Section 6. A carrier shall not participate in the market unless the policy form or certificate form has been filed with and approved by the commissioner.
MA Gen L ch 176k § 8 (2021)
2021 Massachusetts General Laws|Part I - Administration of the Government|Title XXII - Corporations|Chapter 176k - Medicare Supplement Insurance Plans|Section 8 - Employers' or Labor Organizations

Section 8. This chapter shall not apply to a policy or contract of one or more employers' or labor organizations, or of the trustees of a fund established by one or more employers' or labor organizations, or a combination thereof, covering employees or former employees, or a combination thereof, or covering members or former members of labor organizations, or a combination thereof.  All policies issued by a carrier to which section two hundred and five of chapter one hundred and seventy-five applies shall be subject to this chapter.
MA Gen L ch 176k § 9 (2021)
2021 Massachusetts General Laws|Part I - Administration of the Government|Title XXII - Corporations|Chapter 176k - Medicare Supplement Insurance Plans|Section 9 - Contracts in Existence Prior to Effective Date of Chapter

Section 9. Nothing contained herein shall affect, in any way, binding contracts, including the existence, validity or operation of such contracts in existence in the commonwealth prior to the effective date of this chapter.
MA Gen L ch 176l § 2 (2021)
2021 Massachusetts General Laws|Part I - Administration of the Government|Title XXII - Corporations|Chapter 176l - Risk Retention and Risk Purchasing Groups|Section 2 - Charter and License; Application; Plan of Operation or Feasibility Study

Section 2. (A) A risk retention group shall be chartered and licensed under the laws of the commonwealth to write only liability insurance pursuant to the provisions of this chapter and, except as provided elsewhere in this chapter, must comply with (1) all of the laws, rules, regulations and requirements applicable to such insurers chartered and licensed in the commonwealth and with (2) section three to the extent such requirements of said section three are not a limitation on laws, rules, regulations or requirements of the commonwealth.  (B) Before it may offer insurance in any state, a risk retention group shall submit to the commissioner for approval a plan of operation or a feasibility study. In the event of any subsequent material change in any item of the plan of operation or feasibility study, the risk retention group shall submit an appropriate revision or amendment to the commissioner for approval at least ten working days prior to the requested effective date of any such change. The group shall not offer any additional kinds of liability insurance, in the commonwealth or in any other state, until the commissioner approves a revision or amendment of such plan or study.  (C) At the time of filing its application for charter, the risk retention group shall provide to the commissioner in summary form the following information:  (1) the identity of the initial members of the group;  (2) the identity of the persons who organized the group or who will provide administrative services or otherwise influence or control the activities of the group;  (3) the amount and nature of initial capitalization;  (4) the coverages to be afforded; and  (5) the states in which the group intends to operate.