reglab/statecodes huggingface dataset:
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XXII - Corporations › Chapter 176a - Non-Profit Hospital Service Corporations › Section 8i - Home Care Benefits

Section 8I. Any subscription certificate under a group nonprofit hospital service agreement, except certificates which provide supplemental coverage to medicare or other governmental programs which shall be delivered, issued or renewed in the commonwealth, shall provide, as benefits to all group members having a principal place of employment within the commonwealth, for the expense of medically necessary health care services determined to be medically necessary and provided by a participating home health agency to a member in his residence; provided, however, that such residence is neither a hospital nor an institution primarily engaged in providing skilled nursing or rehabilitation services. Said services shall include, but not be limited to, nursing and physical therapy. Additional services such as occupational therapy, speech therapy, medical social work, nutritional consultation services, the services of a home health aid and the use of durable medical equipment and supplies shall be provided to the extent such additional services are determined to be a medically necessary component of said nursing and physical therapy. Said benefits for home care services shall meet all other terms and conditions of the subscriber certificate. The provisions of this section shall not apply to group insurance plans issued pursuant to the provisions of chapter thirty-two B.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XXII - Corporations › Chapter 176a - Non-Profit Hospital Service Corporations › Section 8ii - Coverage for Medically Necessary Acute Treatment or Clinical Stabilization Services

Section 8II. 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 contract between a subscriber and the corporation under an individual or group hospital service plan which is 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 contract between a subscriber and the corporation under an individual or group hospital service plan which is delivered, issued or renewed within the commonwealth, shall cover, without preauthorization, a substance use disorder evaluation ordered pursuant to section 511/2 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.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XXII - Corporations › Chapter 176a - Non-Profit Hospital Service Corporations › Section 8j - Minimum Requirements for Cytologic Screening and Mammographic Examination Expense Benefits

Section 8J. Any contract, except contracts providing supplemental coverage to medicare or other governmental programs, between a subscriber and the corporation under an individual group hospital service plan which shall be delivered, issued or renewed in the commonwealth shall provide, as a basic benefit to all individual subscribers and members within the commonwealth and to all group members having a principal place of employment within the commonwealth, for expense for cytologic screening and mammographic examination. Said benefits shall be at least equal to the following minimum requirements: (a) in the case of benefits for cytologic screening, said benefits shall provide for an annual cytologic screening for women eighteen years of age and older; and (b), in the case of benefits for mammographic examination, said benefits shall provide for a baseline mammogram for women between the ages of thirty-five and forty and for a mammogram on an annual basis for women forty years of age and older.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XXII - Corporations › Chapter 176a - Non-Profit Hospital Service Corporations › Section 8k - Infertility Diagnosis and Treatment Benefits

Section 8K. Any contract, except contracts providing supplemental coverage to medicare or other governmental programs, between a subscriber and the corporation under an individual or group hospital service plan which is delivered, issued for delivery or renewed in the commonwealth while this provision is effective and which provides pregnancy-related benefits shall provide as a benefit for all individual subscribers or members within the commonwealth and all group members having a principal place of employment within the commonwealth, to the same extent that benefits are provided for other pregnancy-related procedures, coverage for medically necessary expenses of diagnosis and treatment of infertility. Said infertility benefits shall meet all other terms and conditions of the subscriber certificate. For purposes of this section, ''infertility' shall mean the condition of an individual who is unable to conceive or produce conception during a period of 1 year if the female is age 35 or younger or during a period of 6 months if the female is over the age of 35. For purposes of meeting the criteria for infertility in this section, if a person conceives but is unable to carry that pregnancy to live birth, the period of time she attempted to conceive prior to achieving that pregnancy shall be included in the calculation of the 1 year or 6 month period, as applicable.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XXII - Corporations › Chapter 176a - Non-Profit Hospital Service Corporations › Section 8kk - Coverage for Medical or Drug Treatments to Correct or Repair Disturbances of Body Composition Caused by HIV Associated Lipodystrophy Syndrome

Section 8KK. Any contract between a subscriber and the corporation under an individual or group hospital service plan which is 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.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XXII - Corporations › Chapter 176a - Non-Profit Hospital Service Corporations › Section 8l - Nonprescription Enteral Formulas for Home Use

Section 8L. Any contract between a subscriber and the corporation under an individual or group hospital service plan that shall be delivered, issued or renewed in the commonwealth shall provide, as benefits to all individual subscribers and members within the commonwealth, coverage for nonprescription enteral formulas for home use for which a physician has issued a written order and which are medically necessary for the treatment of malabsorption caused by Crohn's disease, ulcerative colitis, gastroesophageal reflux, gastrointestinal motility, chronic intestinal pseudo-obstruction, and inherited diseases of amino acids and organic acids. Coverage for inherited diseases of amino acids and organic acids shall include food products modified to be low protein in an amount not to exceed $5,000 annually for any insured individual.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XXII - Corporations › Chapter 176a - Non-Profit Hospital Service Corporations › Section 8ll - Filling of Remaining Portion of Prescription for Covered Drug That Is a Narcotic Substance Earlier Filled in Lesser Quantity

Section 8LL. Any contract between a subscriber and the corporation under an individual or group hospital service plan that is 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.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XXII - Corporations › Chapter 176a - Non-Profit Hospital Service Corporations › Section 8m - Standardized Claim Form

Section 8M. 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.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XXII - Corporations › Chapter 176a - Non-Profit Hospital Service Corporations › Section 8mm - Pain Management Access Plans

Section 8MM. (a) Any contract between a subscriber and the corporation under an individual or group hospital service plan that is 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.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XXII - Corporations › Chapter 176a - Non-Profit Hospital Service Corporations › Section 8n - Off-Label Drug Use; Cancer

Section 8N. Any contract between a subscriber and the corporation under an individual or group hospital service plan that shall be delivered, issued or renewed in the commonwealth, which provides coverage for prescription drugs, shall provide as benefits to all individual subscribers and members and to all groups having a principal place of employment within the commonwealth, coverage for off-label uses of prescription drugs used in the treatment of cancer as defined in, and subject to the restrictions of, sections forty-seven K and forty-seven L of chapter one hundred and seventy-five.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XXII - Corporations › Chapter 176a - Non-Profit Hospital Service Corporations › Section 8nn - Coverage for Tobacco Use Cessation Counseling and Tobacco Cessation Products

[Text of section applicable to policies, contracts and subscription certificates delivered, issued or renewed in the commonwealth on or after January 1, 2020. See 2019, 133, Sec. 26.]
Section 8NN. (a) Any contract between a subscriber and the corporation under an individual or group hospital service plan that is 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 preauthorization.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XXII - Corporations › Chapter 176a - Non-Profit Hospital Service Corporations › Section 8o - Hospital Service Plan Benefits for Bone Marrow Transplants

Section 8O. Any contract between a subscriber and the corporation under an individual or group hospital service plan that shall be delivered, issued or renewed in 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 a bone marrow transplant or transplants for persons who have been diagnosed with breast cancer that has progressed to metastatic disease; provided, however, that said person shall meet the criteria established by the department of public health. The department of public health shall promulgate rules and regulations establishing criteria for eligibility for coverage hereunder which shall be consistent with medical research protocols reviewed and approved by the National Cancer Institute.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XXII - Corporations › Chapter 176a - Non-Profit Hospital Service Corporations › Section 8oo - 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 8OO. Any contract between a subscriber and a corporation under an individual or group hospital service plan 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.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XXII - Corporations › Chapter 176a - Non-Profit Hospital Service Corporations › Section 8p - Items Medically Necessary for Diagnosis and Treatment of Diabetes

Section 8P. A contract between a subscriber and the corporation under an individual or group hospital service plan which provides hospital expense and surgical expense insurance, except contracts providing supplemental coverage to Medicare or other governmental programs, delivered, issued or renewed by agreement between the insurer and the policyholder, within or without the commonwealth, shall provide benefits to all individual subscribers and members within the commonwealth and to all group members having a principal place of employment within the commonwealth for the following items if such items are within a category of benefits or services for which coverage is otherwise afforded by the contract, have been prescribed by a health care professional legally authorized to prescribe such items and if the items are medically necessary for the diagnosis or treatment of insulin-dependent, insulin-using, gestational and non-insulin-dependent diabetes: blood glucose monitors; blood glucose monitoring strips for home use; voice-synthesizers for blood glucose monitors for use by the legally blind; visual magnifying aids for use by the legally blind; urine glucose strips; ketone strips; lancets; insulin; insulin syringes; prescribed oral diabetes medications that influence blood sugar levels; laboratory tests, including glycosylated hemoglobin, or HbAlc, tests; urinary protein/microalbumin and lipid profiles; insulin pumps and insulin pump supplies; insulin pens, so-called; therapeutic/molded shoes and shoe inserts for people who have severe diabetic foot disease when the need for therapeutic shoes and inserts has been certified by the treating doctor and prescribed by a podiatrist or other qualified doctor and furnished by a podiatrist, orthotist, prosthetist or pedorthist; supplies and equipment approved by the Federal Drug Administration for the purposes for which they have been prescribed and diabetes outpatient self-management training and education, including medical nutrition therapy, when provided by a certified diabetes health care provider participating with the hospital service plan or affiliated with a provider participating with the hospital service plan. As used in this section, ''certified diabetes health care provider'' shall mean a licensed health care professional with expertise in diabetes, a registered dietician or a health care provider certified by the National Certification Board of Diabetes Educators as a certified diabetes educator. Nothing in this section shall be construed to require a nonprofit service corporation to contract with a certified diabetes health care provider who is not already under contract with such nonprofit service corporation.
The benefits provided in this section shall meet all other terms and conditions within a subscription certificate. Hospital service plans shall not reduce or eliminate coverage due to the requirements of this section.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XXII - Corporations › Chapter 176a - Non-Profit Hospital Service Corporations › Section 8q - HIV/AIDS Treatment; Off-Label Prescription Drug Coverage

Section 8Q. Any contract between a subscriber and the corporation under an individual or group hospital service plan that shall be delivered, issued or renewed in the commonwealth which provides coverage for prescription drugs shall provide as benefits to all individual subscribers and members within the commonwealth and to all group members having a coverage for off-label uses of prescription drugs used in the treatment of HIV/AIDS as set forth in sections forty-seven O and forty-seven P of chapter one hundred and seventy-five.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XXII - Corporations › Chapter 176a - Non-Profit Hospital Service Corporations › Section 8qq - Coverage for Prescription Eye Drops

Section 8QQ. A contract between a subscriber and the corporation under an individual or group hospital service plan which is 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.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XXII - Corporations › Chapter 176a - Non-Profit Hospital Service Corporations › Section 8r - Coverage of Hospice Services for Terminally Ill Patients

Section 8R. Any contract between a subscriber and the corporation under an individual or group hospital service plan that shall be delivered, 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 for licensed hospice services for terminally ill patients with a life expectancy of six months or less, as set forth and regulated by the provisions of section fifty-seven D of chapter one hundred and eleven and as authorized by a duly licensed physician.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XXII - Corporations › Chapter 176a - Non-Profit Hospital Service Corporations › Section 8rr - Coverage for Mental Health or Substance Use Disorder Services Delivered Through Psychiatric Collaborative Care Model

Section 8RR. (a) For the purposes of this section, ''psychiatric collaborative care model'' shall mean the evidence-based, integrated behavioral health service delivery method in which a primary care team consisting of a primary care provider and a care manager provides structured care management to a patient, and that works in collaboration with a psychiatric consultant that provides regular consultations to the primary care team to review the clinical status and care of patients and to make recommendations.
(b) A contract between a subscriber and the corporation under an individual or group hospital service plan that is delivered, issued or renewed within or without the commonwealth shall provide coverage for mental health or substance use disorder services that are delivered through the psychiatric collaborative care model.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XXII - Corporations › Chapter 176a - Non-Profit Hospital Service Corporations › Section 8s - Nurse Anesthetist and Nurse Practitioner Services

Section 8S. Any contract between a subscriber and the corporation under an individual or group hospital service plan delivered, 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 for services rendered by a certified registered nurse anesthetist or nurse practitioner designated as such certified registered nurse anesthetist or nurse practitioner by the board of registration in nursing pursuant to the provisions of section eighty B of chapter one hundred and twelve; provided, however, that the following conditions are met: (1) the service rendered is within the scope of the certified registered nurse anesthetist's license or nurse practitioner's authorization to practice by the board of registration in nursing; and (2) the policy or contract currently provides benefits for identical services rendered by a provider of health care licensed by the commonwealth.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XXII - Corporations › Chapter 176a - Non-Profit Hospital Service Corporations › Section 8ss - Coverage for Medically Necessary Mental Health Acute Treatment, Community-Based Acute Treatment and Intensive Community-Based Acute Treatment

Section 8SS. (a) For the purposes of this section, the following terms shall have the following meanings unless the context clearly requires otherwise:
''Community-based acute treatment'', 24–hour clinically managed mental health diversionary or step-down services for children and adolescents that is usually provided as an alternative to mental health acute treatment.
''Intensive community-based acute treatment'', intensive 24–hour clinically managed mental health diversionary or step-down services for children and adolescents that is usually provided as an alternative to mental health acute treatment.
''Mental health acute treatment'', 24–hour medically supervised mental health services provided in an inpatient facility, licensed by the department of mental health, that provides psychiatric evaluation, management, treatment and discharge planning in a structured treatment milieu.
(b) A contract between a subscriber and the corporation under an individual or group hospital service plan that is delivered, issued or renewed within the commonwealth shall provide coverage for medically necessary mental health acute treatment, community-based acute treatment and intensive community-based acute treatment and shall not require a preauthorization before the administration of any such treatment; provided, however, that the facility shall notify the carrier of the admission and the initial treatment plan within 72 hours of admission.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XXII - Corporations › Chapter 176a - Non-Profit Hospital Service Corporations › Section 8t - Scalp Hair Prostheses Necessary Due to Cancer or Leukemia Treatment

Section 8T. (a) For the purpose of this section, the following words shall have the following meanings:
''Prosthesis'', an artificial appliance used to replace a lost natural structure; provided, however, that prosthesis shall include, but not be limited to, artificial arms, legs, breasts, scalp hair or glass eyes.
''Scalp hair prosthesis'', an artificial substitute for scalp hair.
(b) Any contracts, except contracts providing supplemental coverage to medicare or other governmental programs, between a subscriber and the corporation under an individual or group hospital service plan which is delivered, issued or renewed in the commonwealth and which provides coverage for any other prosthesis, shall provide, as a benefit 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 expenses for scalp hair prostheses worn for hair loss suffered as a result of the treatment of any form of cancer or leukemia; provided, however, that such coverage shall be subject to a written statement by the treating physician that the scalp hair prosthesis is medically necessary; and provided, further, that such coverage shall be subject to the same limitations and guidelines as other prostheses. Scalp hair prosthesis coverage pursuant to this section shall not exceed an amount of $350 per year.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XXII - Corporations › Chapter 176a - Non-Profit Hospital Service Corporations › Section 8tt - Benefits for Medically Necessary Emergency Services Programs

Section 8TT. A contract between a subscriber and the corporation under an individual or group hospital service plan that is delivered, issued or renewed within or without the commonwealth shall provide benefits on a nondiscriminatory basis for medically necessary emergency services programs, as defined in section 1 of chapter 175.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XXII - Corporations › Chapter 176a - Non-Profit Hospital Service Corporations › Section 8uu - Coverage for Annual Mental Health Wellness Examination

Section 8UU. (a) For the purpose of this section, the following words shall have the following meanings:
''Licensed mental health professional,'' a licensed physician who specializes in the practice of psychiatry, a licensed psychologist, a licensed supervised mental health counselor, a licensed independent clinical social worker, a licensed certified social worker, a licensed mental health counselor, a licensed psychiatric nurse mental health clinical specialist, a licensed psychiatric mental health nurse practitioner, a licensed physician assistant who practices in the area of psychiatry, a licensed alcohol and drug counselor I, as defined in section 1 of chapter 111J of the General Laws, or a licensed marriage and family therapist within the lawful scope of practice for such therapist.
''Mental health wellness examination,'' a screening or assessment that seeks to identify any behavioral or mental health needs and appropriate resources for treatment. The examination may include: (i) observation, a behavioral health screening, education and consultation on healthy lifestyle changes, referrals to ongoing treatment, mental health services and other necessary supports and discussion of potential options for medication; and (ii) age-appropriate screenings or observations to understand a covered person's mental health history, personal history and mental or cognitive state and, when appropriate, relevant adult input through screenings, interviews, and questions.
''Primary care provider'', a health care professional qualified to provide general medical care for common health care problems, who (i) supervises, coordinates, prescribes or otherwise provides or proposes health care services; (ii) initiates referrals for specialist care; and (iii) maintains continuity of care within the scope of practice.
(b) A contract between a subscriber and the corporation under an individual or group hospital service plan which is delivered, issued or renewed within the commonwealth shall provide coverage for an annual mental health wellness examination that is performed by a licensed mental health professional or primary care provider, which may be provided by the primary care provider as part of an annual preventive visit. The examination shall be covered with no patient cost-sharing, provided, however, that cost-sharing shall be required if the applicable plan is governed by the Federal Internal Revenue Code and would lose its tax-exempt status as a result of the prohibition on cost-sharing for this service.
(c) The division of insurance, in consultation with the office of Medicaid, and the department of mental health, shall develop guidelines to implement this section.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XXII - Corporations › Chapter 176a - Non-Profit Hospital Service Corporations › Section 8v - Coverage for Human Leukocyte or Histocompatibility Locus Antigen Testing

Section 8V. Any contract between a subscriber and the corporation under an individual or group hospital service plan, except contracts providing supplemental coverage to Medicare or to other government programs, delivered, issued or renewed by agreement within or without 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 the cost of human leukocyte antigen testing or histocompatibility locus antigen testing that is necessary to establish bone marrow transplant donor suitability. The coverage shall cover the costs of testing for A, B or DR antigens, or any combination thereof, consistent with rules, regulations and criteria established by the department of public health pursuant to section 218 of chapter 111.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XXII - Corporations › Chapter 176a - Non-Profit Hospital Service Corporations › Section 8vv - Coverage for Federally-Defined Preventive Services

[ Text of section added by 2023, 28, Sec. 58 effective July 1, 2023. See 2023, 28, Sec. 115.]
Section 8VV. (a) For the purposes of this section, "federally-defined preventive services'' shall mean: (i) evidence-based items or services that currently have a rating of "A'' or "B'' in the recommendations of the United States Preventive Services Task Force; (ii) immunizations with routine uses in children, adolescents and adults that currently have a recommendation from the Advisory Committee on Immunization Practices of the federal Centers for Disease Control and Prevention with respect to the individual involved; (iii) with respect to infants, children and adolescents, evidence-informed preventive care and screenings provided for in comprehensive guidelines supported by the federal Health Resources and Services Administration; and (iv) with respect to women, such additional preventive care and screenings not described in clause (i) as provided for in comprehensive guidelines supported by the federal Health Resources and Services Administration; provided, however, that "federally-defined preventive services'' shall also include all other preventive services not subject to cost-sharing, as required by established federal regulatory and sub-regulatory guidance issued on or before July 1, 2023.
(b) Any contract between a subscriber and a corporation subject to this chapter, pursuant to an individual or group hospital service plan that is delivered, issued or renewed within the commonwealth shall provide coverage for federally-defined preventive services.
(c) Coverage provided pursuant to this section shall not be subject to any cost-sharing, including, but not limited to, co-payments, co-insurance or any deductible, as required by established federal regulatory and sub-regulatory guidance issued on or before July 1, 2023.
(d) Nothing in this section shall prohibit: (i) coverage for items and services in addition to those recommended by the United States Preventive Services Task Force, the Advisory Committee on Immunization Practices of the federal Centers for Disease Control and Prevention or the federal Health Resources and Services Administration; or (ii) denying coverage for items and services that are not recommended by the United States Preventive Services Task Force, the Advisory Committee on Immunization Practices of the federal Centers for Disease Control and Prevention or the federal Health Resources and Services Administration.
(e) If a recommendation pursuant to subsection (a) is changed during a plan year, a carrier shall not be required to make changes to the health plan during the plan year.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XXII - Corporations › Chapter 176a - Non-Profit Hospital Service Corporations › Section 8x - Coverage for Patient Care Services Under Qualified Clinical Trials

Section 8X. Any contract between a subscriber and the corporation under an individual or group hospital service plan delivered or issued or renewed within the commonwealth shall provide for coverage of patient care services furnished pursuant to qualified clinical trials as defined in, and subject to the requirements and limitations of, section 110L of chapter 175.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XXII - Corporations › Chapter 176a - Non-Profit Hospital Service Corporations › Section 8y - Diagnosis and Treatment of Speech, Hearing and Language Disorders

Section 8Y. Any contract between a subscriber and the corporation under an individual or group hospital service plan that 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 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 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 hospital service plan.
[(f)] Any contracts, except contracts providing supplemental coverage to Medicare or other governmental programs, between a subscriber and the corporation under an individual or group hospital service plan that is delivered, issued or renewed in 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 such person's children 21 years of age or younger, who are insured under such contracts or plans, for the cost of 1 hearing aid per hearing impaired ear up to $2,000 for each hearing aid, as defined under section 196 of chapter 112, every 36 months upon a written statement from the child's treating physician that the hearing aids are necessary regardless of etiology. Coverage under this section shall include all related services prescribed by a licensed audiologist or hearing instrument specialist, as defined in said section 196 of said chapter 112, including the initial hearing aid evaluation, fitting and adjustments and supplies, including ear molds. The insured may choose a higher priced hearing aid and may pay the difference in cost above the $2,000 limit in this section without any financial or contractual penalty to the insured or to the provider of the hearing aid. The benefits in this section shall not be subject to any greater deductible, coinsurance, copayments or out-of-pocket limits than any other benefits provided by the insurer. Nothing in this section shall prohibit a corporation from offering greater coverage for hearing aids than required by this section. This section shall also require coverage for such hearing aids under any non-group policy.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XXII - Corporations › Chapter 176a - Non-Profit Hospital Service Corporations › Section 10a - Preferred Provider Arrangements

Section 10A. Other provisions of this chapter and chapter one hundred and seventy-six G notwithstanding, any nonprofit hospital service corporation, either individually or by contract with a corporation formed under chapter one hundred and seventy-six B, one or more hospitals licensed under chapter one hundred and eleven, one or more health maintenance organizations under chapter one hundred and seventy-six G, physicians registered under chapter one hundred and twelve and other providers of health care licensed or registered pursuant to chapter one hundred and eleven or one hundred and twelve or one or more insurance companies licensed under chapter one hundred and seventy-five, may establish, maintain, operate, own or offer preferred provider arrangements which have been approved by the commissioner under chapter one hundred and seventy-six I.
Provided that contracts governing payment for services rendered to patients covered, by a selective product may not be tied to contracts governing payment for services rendered to other patients.
The entire arrangement or contract between a medical service corporation and a hospital service corporation which involves the operation by one of those entities of a preferred provider program shall be subject to all of the requirements of chapter one hundred and seventy-six I.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XXII - Corporations › Chapter 176a - Non-Profit Hospital Service Corporations › Section 11 - Officers; Duties

Section 11. The president, vice-president, if any, the secretary, assistant secretary, if any, the treasurer, and assistant treasurer, if any, shall be annually sworn and their oaths entered of record in the books of the non-profit hospital service corporation.
Each director shall file with the secretary a written acceptance of the trust before he is qualified to act.
The secretary, the treasurer, and each assistant secretary and each assistant treasurer, if any, of such a corporation shall, before entering upon his duties, give a bond payable to the corporation, conditioned upon the faithful performance of his duties. The bond shall be executed as surety by a surety company authorized to transact business in the commonwealth, and shall be in a form satisfactory to the commissioner of insurance and in such penal sum as the commissioner shall prescribe. If the authority of any such surety company to transact business in the commonwealth is terminated, each officer bonded as aforesaid by such surety company shall forthwith execute a new bond in compliance with this section.
The secretary shall keep a record of the attendance, the votes taken and the manner in which each director votes, and of all other proceedings of all meetings of the directors and subscribers, and such other books and records as the president and directors may require. The records so kept shall be evidence of all elections and of the transactions to which they relate.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XXII - Corporations › Chapter 176a - Non-Profit Hospital Service Corporations › Section 13 - Hospitalization and Medical Service for Officers and Employees of Corporation

Section 13. Any non-profit hospital service corporation may provide for the issuance to its employees of hospital service coverage, medical service coverage, and reimbursement for other health coverage. The term ''employee'' as used in this section shall include an officer.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XXII - Corporations › Chapter 176a - Non-Profit Hospital Service Corporations › Section 14 - Misrepresentation of Terms of Subscriber's Contract

Section 14. No non-profit hospital service corporation, or any officer or agent thereof, shall make, issue, circulate or use, or cause or permit to be made, issued, circulated or used, any written or oral statement misrepresenting the terms of any subscriber's contract issued or to be issued by any non-profit hospital service corporation, or the benefits or privileges promised thereunder.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XXII - Corporations › Chapter 176a - Non-Profit Hospital Service Corporations › Section 15 - Costs of Solicitation of Subscribers and Administration

Section 15. Acquisition costs in connection with the solicitation of subscribers, and the cost of administration shall at all times be limited to such amounts as the commissioner of insurance shall approve as adequate and reasonable, but in any event, such acquisition costs shall not exceed in any one year ten per cent of the earned subscription fees during that year, except that during the first five years after the issuance of a certificate of compliance by said commissioner such corporation may disburse not more than twenty per cent of such amount in each year.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XXII - Corporations › Chapter 176a - Non-Profit Hospital Service Corporations › Section 16 - Acquisition of Real Estate; Leases; Tax Exemption; Limit; Approval of Investments, Sales, Loans and Places of Deposit

Section 16. With the approval of the commissioner of insurance, a corporation subject to this chapter, alone or with one or more nonprofit corporations, the real estate of which is exempt from taxation, may acquire real estate it reasonably expects to use in whole or in part for conducting the business of such corporation or corporations. Real estate so acquired may be leased to other occupants, and when so leased, the exemption from taxes on real estate granted by this chapter or granted by any provision of the general laws to a co-owner shall not apply to that portion of the real estate which is so leased unless such other occupant occupies the leased premises for its purposes and is (a) a charitable organization, as defined in section five of chapter fifty-nine, or (b) a nonprofit corporation organized under the laws of the commonwealth to provide any kind of health service, the real estate of which is exempt from taxation. Nothing in this paragraph shall limit the general investment powers set forth in this section.
No investment, sale or loan shall be made which has not first been authorized by the board of directors, or by a committee thereof charged with the duty of investing or loaning the funds of the corporation; nor shall any deposit be made in a bank or banking institution unless such bank or banking institution has first been approved as a bank of deposit by the board of directors or said committee thereof, and unless the vote authorizing such investment, sale or loan or approval of the place of deposit has been duly recorded in the books of the corporation.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XXII - Corporations › Chapter 176a - Non-Profit Hospital Service Corporations › Section 17 - Submission of Disputes and Controversies

Section 17. Any dispute arising between a corporation subject to this chapter, and any hospital with which such corporation has a contract for hospital service as authorized by this chapter, may with the consent of both parties be submitted to the center for health information and analysis for its decision with respect thereto. Any dispute or controversy arising between a non-profit hospital service corporation and any subscriber, or any person whose subscription certificate has been cancelled, may with the consent of both parties be submitted to the commissioner of insurance for his decision with respect thereto. All decisions and findings of the center for health information and analysis and the commissioner of insurance made under this section shall be final as to the facts.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XXII - Corporations › Chapter 176a - Non-Profit Hospital Service Corporations › Section 18 - Annual Statement of Condition; Verification, Filing, Form, Violations; Applicability of Chapters 176v and 176w

Section 18. Every such corporation subject to this chapter shall annually, on or before the first day of March, file in the office of the commissioner of insurance a statement, verified by at least two of the principal officers of said corporation, showing its condition as of the thirty-first day of December next preceding. Said statement shall be in such form and shall contain such other matters as said commissioner shall prescribe. The commissioner may, for cause shown, extend the filing date of the annual statement, or of schedules or exhibits which are a part of such statement or which are required by the commissioner, for not more than sixty days beyond March first in said year. Any such corporation neglecting to make and file its annual statement in the form and within the time herein specified shall forfeit one hundred dollars for each day during which such neglect continues, and upon notice by said commissioner to that effect its authority to do new business shall cease while such default continues.
Notwithstanding any general or special law to the contrary, chapter 176V shall apply to every corporation subject to this chapter.
Notwithstanding any general or special law to the contrary, chapter 176W shall apply to every corporation subject to this chapter.