reglab/housing_qa huggingface dataset:
MA Gen L ch 176g § 5a (2021)
2021 Massachusetts General Laws|Part I - Administration of the Government|Title XXII - Corporations|Chapter 176g - Health Maintenance Organizations|Section 5a - Divorced or Separated Spouses; Coverage

Section 5A. (a) In the event of the granting of a judgment absolute of divorce or of separate support to which a member of a group health maintenance contract is a party, the person who was the spouse of said member prior to the issuance of such judgment shall be and remain eligible for benefits under said contract, whether or not said judgment was entered prior to the effective date of said contract, without additional premium or examination therefor, as if said judgment had not been entered; provided, however, that such eligibility shall not be required if said judgment so provides. Such eligibility shall continue through the member's participation in the contract until the remarriage of either the member or such spouse, or until such time as provided by said judgment, whichever is earlier.  (b) In the event of the remarriage of the member referred to in paragraph (a), the former spouse thereafter shall have the right, if so provided in said judgment, to continue to receive benefits as are available to the member, by means of the addition of a rider to the family contract or the issuance of an individual contract, either of which may be at additional premium rates determined by the commissioner of insurance to be just and reasonable in accordance with the additional insuring risks involved.  (c) The name, address, and policy number of a person eligible for health insurance coverage pursuant to paragraph (a) or (b), if available, shall be forwarded by such health maintenance organization to the department of public welfare within thirty days of the date when coverage of said person under said paragraph (a) or (b) is commenced.  (d) Notice of cancellation of coverage of the divorced or separated spouse of a member shall be mailed to such divorced or separated spouse at such person's last known address, together with notice of the right to reinstate coverage retroactively to the date of cancellation.  (e) Claims paid on behalf of a divorced or separated spouse or on behalf of a dependent who is not residing with the member shall be paid to the physician, hospital or other provider of covered services or to the person on whose behalf such services were performed, unless the person is a minor child. In the event the person on whose behalf such services were performed is a minor, payment shall be made to the physician, hospital or other provider of such services or to the parent or custodian with whom the child resides.
MA Gen L ch 176g § 6 (2021)
2021 Massachusetts General Laws|Part I - Administration of the Government|Title XXII - Corporations|Chapter 176g - Health Maintenance Organizations|Section 6 - Contracts

Section 6. A health maintenance organization may enter into contractual arrangements with any other person or company for the provision, to the health maintenance organization, of health services, insurance, reinsurance and administrative, marketing, underwriting or other services on a nondiscriminatory basis. A health maintenance organization shall not refuse to contract with or compensate for covered services an otherwise eligible provider solely because such provider has in good faith communicated with one or more of his current, former or prospective patients regarding the provisions, terms or requirements of the organization's products as they relate to the needs of such provider's patients.  No contract between a participating provider of health care services and a health maintenance organization shall be issued or delivered in the commonwealth unless it contains a provision requiring that within 45 days after the receipt by the organization of completed forms for reimbursement to the provider of health care services, the health maintenance organization shall (i) make payments for such services provided, (ii) notify the provider in writing of the reason or reasons for nonpayment, or (iii) notify the provider in writing of what additional information or documentation is necessary to complete said forms for such reimbursement. If the health maintenance organization fails to comply with this paragraph for any claims related to the provision of health care services, said health maintenance organization shall pay, in addition to any reimbursement for health care services provided, interest on such benefits, which shall accrue beginning 45 days after the health maintenance organization's receipt of request for reimbursement at the rate of 1.5 per cent per month, not to exceed 18 per cent per year. The provisions of this paragraph relating to interest payments shall not apply to a claim that the health maintenance organization is investigating because of suspected fraud. No contract between a participating home health agency or a participating licensed hospice agency and a health maintenance organization shall be issued or delivered in the commonwealth that requires the participating home health agency or participating licensed hospice agency to be accredited by the Joint Commission on Accreditation of Healthcare Organizations or other national accrediting body if it is certified for participation in the Medicare program, Title XVIII of the federal Social Security Act, 42 U.S.C. Sections 1395 et seq.
MA Gen L ch 176g § 6a (2021)
2021 Massachusetts General Laws|Part I - Administration of the Government|Title XXII - Corporations|Chapter 176g - Health Maintenance Organizations|Section 6a - Group Health Maintenance Contracts; Contribution Percentages

Section 6A. A health maintenance organization may only enter into a group health maintenance contract with an employer if the group health maintenance contract is offered by that employer to all full-time employees who live in the commonwealth; provided, however, the employer shall not make a smaller health insurance premium contribution percentage amount to an employee than the employer makes to any other employee who receives an equal or greater total hourly or annual salary for each specific or general blanket policy of insurance for all employees. Notwithstanding the foregoing, a health maintenance organization may enter into a group health maintenance contract with an employer that establishes separate contribution percentages for employees covered by collective bargaining agreements.
MA Gen L ch 176g § 6b (2021)
2021 Massachusetts General Laws|Part I - Administration of the Government|Title XXII - Corporations|Chapter 176g - Health Maintenance Organizations|Section 6b - Retroactive Claims Denials for Behavioral Health Services

Section 6B. (a) For the purposes of this section, the following words shall have the following meanings unless the context clearly requires otherwise:  ''Behavioral health services'', as defined in section 1 of chapter 175, or ''services''.  ''Provider'', (i) a mental health clinic or substance use disorder treatment program licensed by the department of public health under chapters 17, 111, 111B or 111E; or (ii) a behavioral, substance use disorder or mental health professional who is licensed under chapter 112 and accredited or certified to provide services and who has provided services under an express or implied contract or with the expectation of receiving payment, other than co-payment, deductible or co-insurance, directly or indirectly from the commission or other entity.  ''Retroactive claims denial'', as defined in section 1 of chapter 175.  (b) An insurer or other entity shall not impose a retroactive claims denial for behavioral health services on a provider unless: (i) less than 12 months have elapsed from the time of submission of the claim by the provider to the insurer or other entity; (ii) the insurer or other entity has furnished the provider with a written explanation of the reason for the retroactive claims denial and, where applicable, a description of additional documentation or any other corrective action required for payment of the claim; and (iii) where applicable, the insurer or other entity responsible for payment allows the provider 30 days to submit additional documentation or to take any other corrective action required for payment of the claim.  (c) Notwithstanding subsection (b), a retroactive claims denial may be allowed after 12 months if: (i) the claim was submitted fraudulently; (ii) the claim, or services for which the claim was submitted, is the subject of legal action; (iii) the claim payment was incorrect because the provider was paid or the insured has already paid for the services identified in the claim; or (iv) the services identified in the claim were not delivered by the provider.  (d) If a retroactive claims denial is imposed because the claim payment is subject to adjustment due to expected payment from a payer other than the insurer or other entity with which the insurer contracts to provide or manage health care services, including mental health and substance use disorder services, the insurer or other entity shall notify the provider not less than 15 days before imposing the retroactive claims denial. The provider shall have 12 months from the date of denial to determine whether the claim is subject to payment by a secondary insurer; provided, however, that if the claim is denied by the secondary insurer due to the insured's transfer or termination of coverage, the insurer shall allow for resubmission of the claim.
MA Gen L ch 176g § 8 (2021)
2021 Massachusetts General Laws|Part I - Administration of the Government|Title XXII - Corporations|Chapter 176g - Health Maintenance Organizations|Section 8 - Public Dissemination of Deceptive or Misleading Materials

Section 8. Public dissemination of any promotional material, evidence of coverage, health maintenance contract or any other statement with respect to a health maintenance organization, which is untrue, deceptive or misleading, shall constitute an unfair and deceptive practice under the provisions of section two of chapter ninety-three A. Every health maintenance organization shall keep on file, available for inspection by the division of insurance, copies of all educational materials, displays, evidences of coverage and all materials of any promotional nature released for public dissemination. The commissioner may forbid the use of any such material if he finds that it is either untrue, deceptive, or misleading.
MA Gen L ch 176g § 9 (2021)
2021 Massachusetts General Laws|Part I - Administration of the Government|Title XXII - Corporations|Chapter 176g - Health Maintenance Organizations|Section 9 - Trade Regulation Practices; Application of Law

Section 9. The provisions of sections 1 to 14K, inclusive, and sections 48 to 68, inclusive, of chapter ninety-three, and chapter ninety-three A shall be applicable to the ownership, organization, operation and health care services provided by a health maintenance organization as authorized by this chapter.
MA Gen L ch 176g § 10a (2021)
2021 Massachusetts General Laws|Part I - Administration of the Government|Title XXII - Corporations|Chapter 176g - Health Maintenance Organizations|Section 10a - Applicability of Chapter 176v to Health Maintenance Organizations Governed by This Chapter

Section 10A. Notwithstanding any general or special law to the contrary, chapter 176V shall apply to a health maintenance organization governed by this chapter.
MA Gen L ch 176g § 10b (2021)
2021 Massachusetts General Laws|Part I - Administration of the Government|Title XXII - Corporations|Chapter 176g - Health Maintenance Organizations|Section 10b - Applicability of Chapter 176w to Health Maintenance Organizations Governed by This Chapter

Section 10B. Notwithstanding any general or special law to the contrary, chapter 176W shall apply to a health maintenance organization governed by this chapter.
MA Gen L ch 176g § 11 (2021)
2021 Massachusetts General Laws|Part I - Administration of the Government|Title XXII - Corporations|Chapter 176g - Health Maintenance Organizations|Section 11 - Contracts With Group Insurance Commission or Local Governments

Section 11. Every health maintenance organization entering into a contract with the group insurance commission under chapter thirty-two A, or a county, city, town, or district under chapter thirty-two B, shall comply with the requirements applicable to health care organizations under said chapters thirty-two A and thirty-two B except that a health maintenance organization proposing to enter into direct contract may elect to have the group insurance commission, or the appropriate county, city, town or district, as the case may be, remit applicable monthly premium costs that would otherwise be payable to a carrier, directly to the health maintenance organization.
MA Gen L ch 176g § 11a (2021)
2021 Massachusetts General Laws|Part I - Administration of the Government|Title XXII - Corporations|Chapter 176g - Health Maintenance Organizations|Section 11a - Alternative Dental Coverage Option

Section 11A. Each employer or other organization which employs or has twenty-five or more employees or members during the full preceding calendar year and which contracts with and contributes to a health maintenance organization for the purpose of providing comprehensive dental benefits to its employees or members, shall, if the health maintenance organization restricts the covered persons in selecting the providers of dental services to a single provider or limited number of providers of dental services, offer its employees and their eligible dependents and members and members' eligible dependents at the time such a contract is offered or renewed, the option of selecting alternative coverage which permits covered persons to obtain dental services from any licensed dentist.  No employer or other organization shall be required to pay for or contribute toward the provision of alternative coverage an amount greater than the premium or cost which it pays or contributes to the health maintenance organization contract which limits the number of providers of dental services.  Notwithstanding the provisions of this section, if any of the employees of an employer required by paragraph one to offer employees the option of selecting such alternative dental coverage as described in said paragraph are represented by a certified collective bargaining representative, the offer of the option of selecting such alternative coverage as required by said paragraph one shall first be made to such collective bargaining representative. Said representative shall have the right not to accept such offer, thereby exempting the employer from the provisions of this section. If such offer is accepted by such representative, the offer of the option of selecting such alternative coverage shall then be made to each employee. Notwithstanding the provisions of this section, a union management trust created pursuant to collective bargaining shall, whenever a restricted dental benefits contract as described in paragraph one is proposed, consider offering such alternative dental coverage as described in said paragraph one, provided, however, said trust may offer the dental plan or plans of its choice.  The commissioner shall promulgate such rules and regulations as are necessary to effectuate the purpose of this section, including procedures for notice to covered persons, employers and other organizations of the provisions of this section.
MA Gen L ch 176g § 12 (2021)
2021 Massachusetts General Laws|Part I - Administration of the Government|Title XXII - Corporations|Chapter 176g - Health Maintenance Organizations|Section 12 - Health Regulations Not Limited

Section 12. Nothing in this chapter shall exempt any person from any applicable provisions of chapters one hundred and eleven or one hundred and twelve, including but not limited to, provisions relating to determinations of need, licensure and regulation of hospitals and clinics and registration of health professionals.
MA Gen L ch 176g § 13 (2021)
2021 Massachusetts General Laws|Part I - Administration of the Government|Title XXII - Corporations|Chapter 176g - Health Maintenance Organizations|Section 13 - Name Restriction

Section 13. No company, person, entity or health care plan not meeting the definition of health maintenance organization specified under this chapter shall use in its name, contract, or literature the term ''health maintenance organization'' or the initials ''HMO''.
MA Gen L ch 176g § 15 (2021)
2021 Massachusetts General Laws|Part I - Administration of the Government|Title XXII - Corporations|Chapter 176g - Health Maintenance Organizations|Section 15 - Bond; Waiver

Section 15. Each health maintenance organization shall furnish to the commissioner evidence of a surety bond in an amount satisfactory to the commissioner or deposit with the commissioner cash or sureties acceptable to him in at least the same amount as a guarantee that the obligation to the enrollees will be performed. The commissioner may waive this requirement if a health maintenance organization has contracted with a carrier as defined in section one for the purpose of reinsurance.
MA Gen L ch 176g § 16 (2021)
2021 Massachusetts General Laws|Part I - Administration of the Government|Title XXII - Corporations|Chapter 176g - Health Maintenance Organizations|Section 16 - Contracts, Rates, Evidence of Coverage; Disapproval of Commissioner

Section 16. The subscriber contracts, rates and evidence of coverage shall be subject to the disapproval of the commissioner. No such contracts shall be approved if the benefits provided therein are unreasonable in relation to the rate charged, nor if the rates are excessive, inadequate or unfairly discriminatory. Classifications shall be fair and reasonable.  To the extent that this chapter is inconsistent with the provisions of chapter one hundred and seventy-six K, and any regulations promulgated thereunder, medicare supplement insurance plans as defined in said chapter one hundred and seventy-six K shall be subject to the provisions of said chapter one hundred and seventy-six K.  To the extent that this section is inconsistent with the provisions of chapter one hundred and seventy-six M and any regulations promulgated thereunder, any nongroup health maintenance contract 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.
MA Gen L ch 176g § 16a (2021)
2021 Massachusetts General Laws|Part I - Administration of the Government|Title XXII - Corporations|Chapter 176g - Health Maintenance Organizations|Section 16a - Disapproval of Certain Health Maintenance Contracts Based on High Deductibles

Section 16A. The commissioner shall not disapprove a health maintenance contract: (i) if it complies with the requirements of 42 U.S.C. Sec. 18022(e); or (ii) on the basis that it includes a deductible that is consistent with the requirements for a high deductible plan as defined in section 223 of the Internal Revenue Code and implementing regulations or guidelines; provided, however, that the maximum deductible shall not be greater than the maximum annual contribution to a health savings account permitted under said section 223 of the Internal Revenue Code; and, provided further, that a deductible equal to the maximum annual contribution to a health savings account shall only be approved for products which include a health savings account permitted under said section 223 of the Internal Revenue Code.
MA Gen L ch 176g § 16b (2021)
2021 Massachusetts General Laws|Part I - Administration of the Government|Title XXII - Corporations|Chapter 176g - Health Maintenance Organizations|Section 16b - Disapproval of Certain Health Maintenance Contracts for Coverage of Young Adults

Section 16B. The commissioner shall not disapprove a health maintenance contract offered as coverage for young adults if the health maintenance contract complies with the minimum standards established under section 10 of chapter 176J.
MA Gen L ch 176g § 17 (2021)
2021 Massachusetts General Laws|Part I - Administration of the Government|Title XXII - Corporations|Chapter 176g - Health Maintenance Organizations|Section 17 - Rules and Regulations; Standardized Claim Form

Section 17. The commissioner may promulgate rules and regulations as are necessary to carry out the provisions of this chapter including but not limited to the licensing of agents, who engage in solicitation of enrollment of a health care plan.  No rule or regulation shall require any health maintenance organization or contract to provide payment of, or referrals for, abortions not necessary to prevent the death of the mother.  The commissioner of insurance is hereby directed to produce a standardized claim form to be utilized by all health insurance companies licensed to do business in the commonwealth for billing purposes.  Said form shall be made available to said companies no later than July first, nineteen hundred and ninety-three.
MA Gen L ch 176g § 17a (2021)
2021 Massachusetts General Laws|Part I - Administration of the Government|Title XXII - Corporations|Chapter 176g - Health Maintenance Organizations|Section 17a - Open Enrollment for Nongroup Medicare Beneficiaries; Period, Notice of Termination

Section 17A. All health maintenance organizations governed by this chapter which enroll medicare beneficiaries shall provide open enrollment for nongroup medicare beneficiaries commencing on February first and ending March thirty-first of each year, for coverage to be effective not later than ninety days from the date of enrollment; provided, however, that nothing contained herein shall preclude additional periods of open enrollment for medicare beneficiaries.  The open enrollment period and coverage effective date for any group health maintenance organization contract covering medicare beneficiaries shall be the same as the open enrollment period of all other group health plan options offered by the employer, representative or group sponsor to the group's members who are eligible for medicare supplemental coverage.  Any such health maintenance organization whose contract with medicare is being terminated shall give each resident of the commonwealth who is covered under a medicare program offered by such health maintenance organization and each nonprofit hospital service corporation and medical service corporation in the commonwealth sixty days notice prior to such termination. Any such health maintenance organization shall cooperate fully in the prompt transfer of coverage to any organization which will assume such coverage.
MA Gen L ch 176g § 19 (2021)
2021 Massachusetts General Laws|Part I - Administration of the Government|Title XXII - Corporations|Chapter 176g - Health Maintenance Organizations|Section 19 - Discrimination Against Abuse Victims in Terms of Health Maintenance Contract

Section 19. No health maintenance organization 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 health maintenance contract 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 health maintenance organization 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.