reglab/statecodes huggingface dataset:
Code of Massachusetts Regulations › 211 CMR - DIVISION OF INSURANCE › Title 211 CMR 65.00 - Long-term Care Insurance › Section 65.01 - Purpose

Current through Register 1525, July 5, 2024
The purpose of
				211 CMR
				65.00 is to provide for full and fair disclosure of
				the provisions of long-term care insurance policies offered in Massachusetts
				and to promote the public interest by protecting applicants for long-term care
				insurance from unfair or deceptive sales and enrollment practices.
				211 CMR
				65.00 establishes minimum standards for individual
				long-term care insurance policies and minimum standards for disclosure,
				marketing and agent training for both individual long-term care insurance
				policies and group long-term care insurance policies that are not
				employment-based.
				211 CMR
				65.00 is intended to facilitate public understanding
				and comparison of long-term care policies, and to encourage flexibility and
				responsible innovation in the development of long-term care
				insurance.
Code of Massachusetts Regulations › 211 CMR - DIVISION OF INSURANCE › Title 211 CMR 65.00 - Long-term Care Insurance › Section 65.02 - Applicability

Current through Register 1525, July 5, 2024
211 CMR
				65.00, unless otherwise stated herein, applies to
				long-term care insurance policies or certificates offered in Massachusetts
				after February 25, 2005. The requirements contained in
				211 CMR
				65.00 are in addition to any other applicable
				statutory provisions or lawful regulations, including
				211 CMR 40.00 and
				211 CMR 42.00 where
				applicable. They do not in any way excuse any material noncompliance on the
				part of any agent or carrier marketing long-term care insurance regarding the
				provisions of any other law or statute. Unless otherwise stated,
				211 CMR
				65.00 does not apply to an employment-based group
				policy.
Code of Massachusetts Regulations › 211 CMR - DIVISION OF INSURANCE › Title 211 CMR 65.00 - Long-term Care Insurance › Section 65.03 - Authority

Current through Register 1525, July 5, 2024
211 CMR
				65.00 is issued under the authority of M.G.L. c. 118E,
				c. 175 § 108, and c. 176D.
Code of Massachusetts Regulations › 211 CMR - DIVISION OF INSURANCE › Title 211 CMR 65.00 - Long-term Care Insurance › Section 65.05 - Minimum Standards for Individual Policies

Current through Register 1525, July 5, 2024
(1)
Benefit Eligibility
			 Standards.
(a)
Benefit Triggers
.
1.
			 Individual policies that are not intended to be federally qualified may not
			 include benefit eligibility standards that are more stringent than a
			 requirement that the insured be unable to perform at least two Activities of
			 Daily Living due to a loss of functional capacity or severe cognitive
			 impairment .
2. Individual policies
			 that are intended to be federally qualified are required to meet the standards
			 set forth in the federal Internal Revenue Code and related federal
			 regulations.
Code of Massachusetts Regulations › 211 CMR - DIVISION OF INSURANCE › Title 211 CMR 65.00 - Long-term Care Insurance › Section 65.06 - Mandatory Benefit Offers for Individual Policies

Current through Register 1525, July 5, 2024
(1)
Inflation Adjustment
			 Benefit.
(a) A carrier shall
			 make available, at the time of application, an option to increase benefits in
			 order to adjust for or mitigate against future inflation. The applicant must be
			 informed regarding the cost of this benefit.
(b) The initial option to purchase an
			 inflation adjustment benefit must be offered to every applicant without
			 additional underwriting.
(c) The
			 carrier must require the applicant to specifically reject this benefit on the
			 application if he/she chooses not to include this benefit in the individual
			 policy.
Code of Massachusetts Regulations › 211 CMR - DIVISION OF INSURANCE › Title 211 CMR 65.00 - Long-term Care Insurance › Section 65.07 - Form and Rate Filing Procedures for Individual Policies

Current through Register 1525, July 5, 2024
(1) Carriers shall file all individual policy
			 forms, including applications, disclosure statements and replacement forms, and
			 associated rates pursuant to the provisions of
			 211 CMR
			 42.06.
(2) Application forms must meet the
			 requirements set forth in
			 211 CMR
			 42.08,
			 211 CMR
			 42.09(2), 211 CMR 42.99,
			 M.G.L. c. 175I and any other applicable Massachusetts statute or
			 regulation.
(3) In the event that
			 any provision of
			 211 CMR 42.00 is inconsistent
			 with the provisions of
			 211 CMR
			 65.00, the provisions of
			 211 CMR
			 65.00 shall govern all matters concerning any policy
			 form that is within the definition of long-term care insurance in
			 211 CMR
			 65.00.
Code of Massachusetts Regulations › 211 CMR - DIVISION OF INSURANCE › Title 211 CMR 65.00 - Long-term Care Insurance › Section 65.08 - Requirements for Agent Training and Marketing

Current through Register 1525, July 5, 2024
(1)
			 Each carrier shall provide appropriate training to agents about its long-term
			 care insurance products, maintain records regarding agents who have
			 satisfactorily completed such training and file with the commissioner lists
			 identifying those agents who have completed the carrier's long-term care
			 insurance training program.
(2) All
			 long-term care insurance marketing and advertising shall conform to the
			 provisions of
			 211 CMR 40.00. In addition,
			 carriers shall establish auditable internal marketing procedures, methods for
			 assuring compliance by agents, and prohibitions against twisting, high-pressure
			 tactics and cold-lead advertising.
(3) All agents or persons marketing a
			 carrier's long-term care insurance shall clearly identify which plans being
			 offered are individual products and which are group products. When marketing
			 group products, the agent shall clearly identify the name of the group
			 policyholder and any conditions that the eligible person must satisfy to join
			 and remain a member of the group.
(4) All agents marketing a carrier's
			 long-term care insurance shall disclose to potential applicants the name of the
			 carrier that the agent represents in the sale. The carrier's name must be
			 disclosed on any and all printed sales or appropriate materials provided,
			 distributed or shown to potential applicants and/or during presentations made
			 to potential applicants in association with a sale, whether part of a
			 presentation or not.
(5) All agents
			 marketing a carrier's long-term care insurance policy must disclose the fact
			 that the agent receives compensation in connection with the sale or replacement
			 of alllong-term care insurance.
(6)
			 All agents marketing a carrier's long-term care insurance shall not
			 misrepresent their expertise, qualifications or training to potential clients
			 and shall not comment on the legal or tax implications of purchasing long-term
			 care insurance to the extent that they lack the training, qualification or
			 license to provide such advice.
(7)
			 A carrier whose agent fails to comply with any provisions of
			 211 CMR
			 65.00, including, but not limited to, 211 CMR 65.08,
			 will be deemed to have committed an unfair and deceptive act in the business of
			 insurance subject to M.G.L. c. 176D.
Code of Massachusetts Regulations › 211 CMR - DIVISION OF INSURANCE › Title 211 CMR 65.00 - Long-term Care Insurance › Section 65.10 - Protection Against Unintentional Lapse

Current through Register 1525, July 5, 2024
No individual or group long-term care insurance policy may be
				issued unless it complies with the following:
(1)
Notice of Nonpayment of
			 Premiums Before Lapse or Termination
. No individual or group
			 longterm care insurance policy may be issued until the carrier has received
			 from the applicant either a written designation of at least one person, in
			 addition to the applicant, who is to receive notice of lapse or termination of
			 the policy or certificate for nonpayment of premium, or a written waiver dated
			 and signed by the applicant electing not to designate additional persons to
			 receive notice. In the case of an applicantwho elects not to designate an
			 additional person, the waiver shall state: "Protection against unintended
			 lapse. I understand that I have the right to designate at least one person
			 other than myself to receive notice of lapse or termination of this long-term
			 care insurance policy for nonpayment of premium. I understand that notice shall
			 not be given until 30 days after a premium is due and unpaid. I elect NOT to
			 designate a person to receive this notice." The carrier shall notify theinsured
			 of the right to change this written designation, no less often than once every
			 two years.
(2)
Lapse or
			 termination for nonpayment of premium
. No individual or group
			 long-term care insurance policy shall lapse or be terminated for nonpayment of
			 premium unless the carrier, at least 30 days before the effective date of the
			 lapse or termination, has given notice to the insured and to those persons
			 designated pursuant to 211 CMR 65.10(1), at the address provided by the insured
			 for purposes ofreceivingnotice of lapse or termination. Notice shall be given
			 by first class United States mail, postage prepaid; and notice may not be given
			 until 30 days after a premium is due and unpaid. Notice shall be deemed to have
			 been given as of ten days after the date of mailing.
(3)
Reinstatement
.
			 All individual or group long-term care insurance policies shallinclude a
			 provision for reinstatement of coverage, in the event of lapse, if the carrier
			 is provided proof that the policyholder or certificateholder was cognitively
			 impaired or had a loss of functional capacity before expiration of the policy's
			 grace period. Reinstatement shallbeavailableto the insured if requested within
			 five months after termination, and shall allow for the collection of past due
			 premium, where appropriate.
Code of Massachusetts Regulations › 211 CMR - DIVISION OF INSURANCE › Title 211 CMR 65.00 - Long-term Care Insurance › Section 65.11 - Prohibition Against Post Claims Underwriting

Current through Register 1525, July 5, 2024
(1) All applications and enrollment forms for
			 individual and group long-term care insurance policies, except those that are
			 guaranteed issue, shall contain clear and unambiguous questions designed to
			 ascertain the health condition of the applicant.
(2) If an application or enrollment form
			 contains a question that asks whether the applicant has had medication
			 prescribed by a physician, then it must also ask the applicant to list the
			 medication that has been prescribed and the reason that the medication was
			 prescribed.
(3) Except for policies
			 that are guaranteed issue:
(a) The following
			 language shall be set out conspicuously near the applicant's signature block on
			 an application:
"Caution: If your answers on this application are incorrect or
				untrue, [carrier] has the right to deny benefits or rescind your
				policy."
(b) The following
			 language, or language substantially similar to the following, shall be set out
			 conspicuously on the policy, as well as the outline of coverage, at the time of
			 delivery:
"Caution: The issuance of this long-term care insurance
				[policy] [certificate] is based upon your responses to the questions on your
				application. A copy of your [application] [enrollment form] [is enclosed] [was
				retained by you when you applied]. If your answers were incorrect or untrue as
				of the date you signed the application, the carrier has the right to deny
				benefits or rescind your policy subject to the [time limit on certain defenses,
				incontestable] section of your policy. The best time to clear up any questions
				is now, before a claim arises! If, for any reason, any of your answers are
				incorrect, contact the carrier at this address: [insert address]"
(c) A carrier may not deny any
			 claims for services under a long-term care policy issued to an applicant age 80
			 or older unless the carrier obtained any one of the following prior to issuing
			 the policy:
1. a report of a physical
			 examination;
2. an assessment of
			 functional capacity;
3. an
			 attending physician's statement; or
4. copies of medical records.
Code of Massachusetts Regulations › 211 CMR - DIVISION OF INSURANCE › Title 211 CMR 65.00 - Long-term Care Insurance › Section 65.12 - Severability

Current through Register 1525, July 5, 2024
If any section or portion of a section of
				211 CMR
				65.00, or the applicability thereof to any person or
				circumstance is held invalid by any Court of competent jurisdiction, the
				remainder of
				211 CMR
				65.00, or the applicability thereof to other persons
				or circumstances, shall not be affected thereby.
Code of Massachusetts Regulations › 211 CMR - DIVISION OF INSURANCE › Title 211 CMR 65.00 - Long-term Care Insurance › Section 65.100 - Policy Illustration Form

Current through Register 1525, July 5, 2024
[INSURANCE COMPANY NAME AND ADDRESS]
LONG-TERM CARE INSURANCE POLICY ILLUSTRATION FORM
Click
				here to view image
Click
				here to view image
Code of Massachusetts Regulations › 211 CMR - DIVISION OF INSURANCE › Title 211 CMR 66.00 - Small Group Health Insurance › Section 66.02 - Applicability and Scope

Current through Register 1525, July 5, 2024
(1)
								211 CMR
			 66.00 applies to all Health Benefit Plans offered,
			 made effective, issued, renewed, delivered or issued for delivery to any
			 Eligible Small Business or to any Eligible Individual under M.G.L. c. 176J,
			 whether issued directly by a Carrier, through the Connector, through an
			 association, a Group Purchasing Cooperative, or through an
			 Intermediary.
(2) Nothing in
			 211 CMR
			 66.00 prohibits a Carrier that offers health insurance
			 to a business of more than 50 Eligible Employees from offering insurance in
			 accordance with the provisions of
			 211 CMR
			 66.00.
Code of Massachusetts Regulations › 211 CMR - DIVISION OF INSURANCE › Title 211 CMR 66.00 - Small Group Health Insurance › Section 66.04 - Minimum Coverage Standards

Current through Register 1525, July 5, 2024
(1)
Offerings and Open Enrollment
.
(a) Unless otherwise provided in
			 211
			 CMR 66.04, every Carrier shall make available
			 to every Eligible Individual and every Eligible Small Business a certificate
			 that evidences coverage for every Health Benefit Plan that it provides to any
			 other Eligible Individual or Eligible Small Business whether issued or renewed
			 to a trust, association or other entity that is not a Group Health Plan, as
			 well as to their Eligible Dependents. Additionally, a Carrier may offer certain
			 Health Benefit Plans, including Catastrophic Health Benefit Plans and
			 Child-only Health Benefit Plans. Every Carrier must accept for enrollment any
			 Eligible Individual or Eligible Small Business that seeks to enroll in a Health
			 Benefit Plan as provided herein; however, a Carrier shall only contract to sell
			 a Health Benefit Plan to cover an Eligible Individual and Eligible Dependents
			 during an annual open enrollment period, except as follows:
1. A Carrier shall enroll an Eligible
			 Individual into a health plan if such individual requests coverage within 63
			 days of termination of any prior coverage that meets the ACA minimum essential
			 coverage requirements.
2. A Carrier
			 shall enroll an Eligible Individual into a health plan if such individual
			 requests coverage within 63 days of experiencing another qualifying or ACA
			 triggering event, and in doing so the Carrier must comply with the ACA and
			 Exchange enrollment requirements, as applicable.
3. A Carrier shall enroll an Eligible
			 Individual who has been granted a waiver by the Office of Patient
			 Protection.
Code of Massachusetts Regulations › 211 CMR - DIVISION OF INSURANCE › Title 211 CMR 66.00 - Small Group Health Insurance › Section 66.05 - Renewability

Current through Register 1525, July 5, 2024
(1) Except as provided in
			 211
			 CMR 66.05(2), every Health
			 Benefit Plan shall be renewable as required by the Health Insurance Portability
			 and Accountability Act of 1996.
(2)
			 A Carrier is not required to renew the Health Benefit Plan of an Eligible Small
			 Business if the small business:
(a) has not
			 paid the required premiums; or
(b)
			 has committed fraud, misrepresented whether a person is an Eligible Employee,
			 or misrepresented information necessary to determine the size of a group, the
			 Participation Rate of a group, or the premium for a group; or
(c) failed to comply in a material manner
			 with Health Benefit Plan provisions including Carrier requirements regarding
			 employer contributions to group premiums; or
(d) fails, at the time of renewal, to satisfy
			 the definition of an Eligible Small Business or meet the Participation
			 Requirements of the Health Benefit Plan; or
(e) fails to comply with reasonable requests
			 to verify the information described in
			 211
			 CMR 66.04(1)(g);
			 or
(f) is not actively engaged in
			 business.
Code of Massachusetts Regulations › 211 CMR - DIVISION OF INSURANCE › Title 211 CMR 66.00 - Small Group Health Insurance › Section 66.06 - Nondiscriminatory Offer of Coverage

Current through Register 1525, July 5, 2024
(1) No Carrier
			 may exclude any Eligible Individual, Eligible Employee, or Eligible Dependent
			 from a Health Benefit Plan on the basis of age, occupation, actual or expected
			 health condition, claims experience, duration of coverage, or medical
			 condition, except that a Carrier may offer a Catastrophic Health Benefit Plan
			 or a Child-only Health Benefit Plan in accordance with the ACA
			 requirements.
(2) No Carrier may
			 modify the coverage of an Eligible Individual, Eligible Employee, or Eligible
			 Dependent through riders or endorsements, or otherwise restrict or exclude
			 coverage for certain diseases or medical conditions otherwise covered by the
			 Health Benefit Plan except as permitted under
			 211 CMR
			 66.00.
(3)
			 No Health Benefit Plan issued to Eligible Individuals, Eligible Employees, or
			 Eligible Dependents may include preexisting condition provisions that exclude
			 coverage.
(4) No Health Benefit
			 Plan may include waiting periods.
Code of Massachusetts Regulations › 211 CMR - DIVISION OF INSURANCE › Title 211 CMR 66.00 - Small Group Health Insurance › Section 66.09 - Eligibility Criteria: Exclusion/Limitation of Mandated Benefits in Health Benefit Plans

Current through Register 1525, July 5, 2024
(1) Notwithstanding
			 any law to the contrary, Carriers may offer, as permitted under M.G.L. c. 176J,
			 § 6, to Eligible Small Businesses Health Benefit Plans that exclude some
			 or all Mandated Benefits, provided, however, that Carriers offer such Health
			 Benefit Plans only to Eligible Small Businesses which did not provide health
			 insurance to their employees as of April 1, 1992 and that such Health Benefit
			 Plans shall not exclude or limit Mandated Benefits for more than a five-year
			 period. An Eligible Small Business must have existed in 1992 in order to be
			 subject to
			 211
			 CMR 66.09(1).
(2) Notwithstanding
			 211
			 CMR 66.09(1), all Health
			 Benefit Plans offered to Eligible Small Businesses must include the following:
(a) dependent coverage for newborn infants,
			 adoptive children and newborn infants of a dependent as described in M.G.L.
			 chs. 175, § 47C; 176A, § 8B; 176B, § 4C and 176G, §
			 4;
(b) continued health care
			 coverage for divorced or separated spouses as described in M.G.L. chs. 175,
			 § 110I; 176A, § 8F; 176B, § 6B and 176G, § 5A;
			 and
(c) coverage for a certain
			 period after an Insured leaves insured group/limited extension of benefits as
			 described in M.G.L. chs. 175, §§ 110D and 110G; 176A, § 8D;
			 176B, § 6A and 176G, § 4A.
Code of Massachusetts Regulations › 211 CMR - DIVISION OF INSURANCE › Title 211 CMR 66.00 - Small Group Health Insurance › Section 66.10 - Connector Seal of Approval Plans

Current through Register 1525, July 5, 2024
(1) A Carrier
			 that marketed a Health Benefit Plan subject to M.G.L. c. 176J, and 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 Benefit Plans sold, issued, delivered, made effective or
			 renewed to Eligible Small Businesses or Eligible Individual pursuant to its
			 license under M.G.L. chs. 175, 176A, 176B or 176G, must file a Health Benefit
			 Plan with the Connector each calendar year.
(3) Neither an Eligible Individual or
			 Eligible Employee, nor an Eligible Dependent shall be considered to be enrolled
			 in a Health Benefit Plan issued pursuant to the Carrier's authority under
			 M.G.L. chs. 175, 176A or 176B if the Health Benefit Plan is sold, issued,
			 delivered, made effective or renewed to said employee or Eligible Dependent as
			 a supplement to a Health Benefit Plan subject to licensure under M.G.L. c.
			 176G.
Code of Massachusetts Regulations › 211 CMR - DIVISION OF INSURANCE › Title 211 CMR 66.00 - Small Group Health Insurance › Section 66.11 - Disclosure

Current through Register 1525, July 5, 2024
Every Carrier must make reasonable disclosure in plain English
				to prospective small group Insureds and prospective individual Insureds, as
				part of its solicitation and sales material, of:
(1) for a small group, the Participation
			 Requirements of the Carrier with regard to each Health Benefit Plan;
(2) for a small group, exclusion or
			 limitation of Mandated Benefits;
(3) mandatory offer and renewal
			 provisions;
(4) rating limitations
			 according to
			 211
			 CMR 66.07; and
(5) availability of Health Benefit Plans; and
			 any health insurance coverage offering that is limited to a particular service
			 area or to employees that live in the service area, 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.
Code of Massachusetts Regulations › 211 CMR - DIVISION OF INSURANCE › Title 211 CMR 66.00 - Small Group Health Insurance › Section 66.12 - Health Plan Filing and Reporting Requirements

Current through Register 1525, July 5, 2024
(1) Carriers must file all Health Benefit
			 Plans offered under
			 211 CMR
			 66.00 with the Division. A Carrier that may require
			 Eligible Small Groups with five or fewer Eligible Employees and/or Eligible
			 Individuals to obtain coverage through an Intermediary, shall file a list of
			 those Intermediaries, with associated contact information as further provided
			 in 211 CMR
			 66.12(3), prior to requiring
			 those Eligible Small Groups or individuals to go through an Intermediary to
			 obtain health coverage.
(2)
Carrier Reporting Requirements
. On or before March
			 31st, the Division will collect reports that contain
			 at least the following information in a format specified by the Commissioner:
(a) Total number of Health Benefit Plans
			 subject to M.G.L. c. 176J offered in Massachusetts during the preceding
			 calendar year;
(b) Total number of
			 lives covered under Health Benefit Plans subject to M.G.L. c. 176J offered in
			 Massachusetts, as of the close of the preceding calendar year;
(c) Number of Eligible Individuals and their
			 Eligible Dependents covered under Health Benefit Plans subject to M.G.L. c.
			 176J offered in Massachusetts, as of the close of the preceding calendar
			 year;
(d) Number of Eligible
			 Employees and their Eligible Dependents covered under Health Benefit Plans
			 subject to M.G.L. c. 176J offered in Massachusetts, as of the close of the
			 preceding calendar year;
(e) Number
			 of Eligible Employees and their eligible dependents covered under Health
			 Benefit Plans subject to M.G.L. c. 176J with limited or no mandated benefits
			 offered in Massachusetts, as of the close of the preceding calendar
			 year;
(f) A statement as to whether
			 a Carrier requires Eligible Individuals and/or Eligible Small Groups of five or
			 fewer Eligible Employees to enroll through an Intermediary or through the
			 Connector. If the Carrier requires Eligible Individuals and/or Eligible Small
			 Groups of five or fewer Eligible Employees to enroll through an Intermediary
			 the report must also contain:
1. The name,
			 address and phone number of the Intermediary; and
2. The Intermediary's membership
			 requirements, including any fees paid by members to join or maintain membership
			 in the Intermediary.
Code of Massachusetts Regulations › 211 CMR - DIVISION OF INSURANCE › Title 211 CMR 66.00 - Small Group Health Insurance › Section 66.13 - Severability

Current through Register 1525, July 5, 2024
If any section or portion of a section of
				211 CMR
				66.00, or the applicability thereof to any person or
				circumstance is held invalid by any court of competent jurisdiction, the
				remainder of
				211 CMR
				66.00, or the applicability thereof to other persons
				or circumstances, shall not be affected thereby.
Code of Massachusetts Regulations › 211 CMR - DIVISION OF INSURANCE › Title 211 CMR 67.00 - Workers' Compensation Self-insurance Groups › Section 67.01 - Purpose, Scope and Applicability

Current through Register 1525, July 5, 2024
The purpose of
				211 CMR 67.00 is to implement
				the provisions of M.G.L. c. 152, §§ 25E through 25U governing the
				formation, operation and oversight of workers' compensation self-insurance
				groups in the Commonwealth.
				211 CMR 67.00 applies to all
				workers' compensation self-insurance groups.
Code of Massachusetts Regulations › 211 CMR - DIVISION OF INSURANCE › Title 211 CMR 67.00 - Workers' Compensation Self-insurance Groups › Section 67.03 - General Provisions

Current through Register 1525, July 5, 2024
(1) A workers'
			 compensation self-insurance group shall not be considered to be an insurance
			 company and shall not be subject to the provisions of M.G.L. c. 175 or any
			 regulations thereunder except as otherwise provided in M.G.L. c. 152 or
			 211 CMR 67.00.
(2) A workers' compensation self-insurance
			 group shall be subject to all provisions of M.G.L. c. 152 and all regulations
			 promulgated thereunder governing the conduct of insurance companies with
			 respect to the payment of workers' compensation benefits, and shall be subject
			 to all fees, fines, penalties and assessments levied upon insurance companies
			 for failure to comply with the claim procedures of M.G.L. c. 152 and any
			 regulations promulgated thereunder, and shall be considered to be self-insurers
			 for the purposes of M.G.L. c. 176D.
(3) A group shall appoint the Commissioner as
			 its attorney to receive service of legal process issued against it in the
			 Commonwealth, in accordance with the provisions of M.G.L. c. 175, § 151,
			 Clause Third. The appointment shall be irrevocable, shall bind any successor in
			 interest and shall remain in effect as long as there remain any obligations or
			 liabilities of the group for workers' compensation benefits.
(4) At least 70% of the members of a group
			 shall be experience rated pursuant to the Experience Rating Plan filed with the
			 Worker's Compensation Rating and Inspection Bureau of Massachusetts (WCRIB),
			 and approved by the Commissioner.
(5) No group may have less than $250,000 of
			 annual gross premium nor a combined provable net worth of all its members of
			 less than $1,000,000.
(6) The
			 principal office of the group shall be located in the Commonwealth.
Code of Massachusetts Regulations › 211 CMR - DIVISION OF INSURANCE › Title 211 CMR 67.00 - Workers' Compensation Self-insurance Groups › Section 67.04 - Corporations and Subsidiaries; Eligibility; Guarantee

Current through Register 1525, July 5, 2024
A person and its affiliates shall be considered as one entity
				for the purposes of
				211 CMR 67.00, provided
				that:
(1) such person and each of its
			 affiliates shall comply with all the filing requirements of
			 211 CMR
			 67.06 applicable to a member of a group;
			 and
(2) such person has signed as
			 guarantor to ensure payment of claims by its affiliates.
Code of Massachusetts Regulations › 211 CMR - DIVISION OF INSURANCE › Title 211 CMR 67.00 - Workers' Compensation Self-insurance Groups › Section 67.05 - Certification to Act as a Self-insurance Group

Current through Register 1525, July 5, 2024
(1)
			 No person, association, or entity shall act as a workers' compensation
			 self-insurance group unless it has been approved by the Commissioner.
(2) The Commissioner may decline to approve
			 an application for a certificate of approval if the group is unable to
			 demonstrate that it is able to meet all obligations and requirements of M.G.L.
			 c. 152 and
			 211 CMR 67.00.
(3) On finding that the proposed group has
			 met all requirements of the law and of
			 211 CMR 67.00, the
			 Commissioner shall issue the group a certificate of approval. Should the
			 Commissioner find that the proposed group does not meet such requirements, he
			 or she shall issue an order denying the group a certificate, setting forth the
			 reasons for the denial. The certificate of approval shall not become effective
			 until the group notifies the Office of Insurance of the Department of
			 Industrial Accidents of the names and addresses of the members of the group,
			 their policy numbers, and the effective date of such coverage. A group shall
			 notify the Commissioner if the group fails to commence operations within 60
			 days of approval. Such notification shall be in writing and shall state the
			 reasons therefor. A group shall forfeit its certificate of approval if it fails
			 to commence operations, as constituted in the form approved by the
			 Commissioner, within 90 days of its approval.
(4) In addition to the filing requirements
			 described in
			 211 CMR
			 67.06, the following factors, where
			 applicable, shall be considered in determining whether or not the group will be
			 able to meet its obligations:
(a) ratio of
			 net worth to annual self-insured retention;
(b) ratio of current assets to current
			 liabilities;
(c) ratio of debt to
			 net worth;
(d) history of
			 profitability of the members;
(e)
			 organizational structure, risk management programs and loss control programs,
			 including services contracted for by the board of trustees or
			 administrator;
(f) background,
			 experience and financial condition of the administrator;
(g) composition of the board of
			 trustees;
(h) claims history of the
			 members;
(i) source and reliability
			 of financial information;
(j) ratio
			 of net worth to annual premium contribution;
(k) number of employees and payroll data by
			 workers' compensation class code;
(l) ability to meet the financial
			 requirements prescribed in
			 211 CMR
			 67.08;
(m) excess insurance coverages and proposed
			 excess insurer;
(n) relationship of
			 self-insured retention and claims history to excess insurance
			 coverages;
(o) amount of the
			 group's security bond or deposit;
(p) guarantee by parent company;
(q) SEC Form 10K or 10Q, where
			 applicable;
(r) reasonableness of
			 administrative and other expenses;
(s) any other factors which may affect the
			 ability of a group to meet its workers' compensation obligations.
Code of Massachusetts Regulations › 211 CMR - DIVISION OF INSURANCE › Title 211 CMR 67.00 - Workers' Compensation Self-insurance Groups › Section 67.06 - Application for Certificate of Approval

Current through Register 1525, July 5, 2024
(1)
General Provisions
.
(a) A proposed workers' compensation
			 self-insurance group shall file with the Commissioner its application for a
			 certificate of approval accompanied by a non-refundable filing fee in the
			 amount of $100.00.
(b) The
			 Commissioner shall evaluate the information provided in the application to
			 assure that no gaps in funding exist and that funds necessary to pay workers'
			 compensation benefits shall be available on a timely basis.
(c) The Commissioner shall conduct an initial
			 review of each application to determine if it is complete. The Commissioner
			 shall act upon a completed application for a certificate of approval within 90
			 days.
(d) The group shall
			 immediately notify the Commissioner of any change in the information required
			 to be filed by 211 CMR 67.06.
(e)
			 All information provided by an applicant during the application process shall
			 be given confidential treatment and shall not be subject to subpoena or made
			 public by the Commissioner or any other person, except by the applicant,
			 without the prior written consent of such applicant, unless the Commissioner,
			 after giving the applicant notice and opportunity to be heard, determines that
			 the public interest would be served by the publication thereof, in which event
			 he or she may publish all or any part thereof in such manner as he or she may
			 consider appropriate. Notwithstanding the foregoing, once an application has
			 been approved by the Commissioner it shall be made available to the public;
			 provided, however, that if a group wishes, it may submit two complete sets of
			 statements, one with all identifying information blacked out or deleted, and
			 the other set complete with all the identifying information, and the group's
			 underwriting guidelines, for inclusion in the financial examination
			 file.
Code of Massachusetts Regulations › 211 CMR - DIVISION OF INSURANCE › Title 211 CMR 67.00 - Workers' Compensation Self-insurance Groups › Section 67.07 - Board of Trustees

Current through Register 1525, July 5, 2024
(1) Each group
			 shall be operated by a board of trustees consisting of at least three persons
			 elected by the members for stated terms of office. At least b of the trustees
			 of any group containing private employers shall be employees, officers or
			 directors of members. All trustees of public employer groups shall be elected
			 officials or employees of public entities within the Commonwealth. No person
			 employed by the administrator of a group, or by any company or organization
			 affiliated with the administrator, shall serve on the board of trustees of any
			 group containing private employers. All trustees shall be residents of the
			 Commonwealth or officers of companies authorized to do business in the
			 Commonwealth.
(2) The board of
			 trustees of each group shall ensure that all compensable claims are paid
			 promptly and shall take all necessary precautions to safeguard the assets of
			 the group, including the following:
(a)
			 maintain responsibility for all monies collected or disbursed by the group and
			 segregate all monies into a claims fund account and an administrative fund
			 account;
(b) designate an
			 administrator to carry out the policies of the board of trustees and to provide
			 day-to-day management of the group. The board shall enter into a written
			 agreement with the administrator, which shall include, but not be limited to, a
			 description of the duties, responsibilities and compensation for the
			 administrator. The written agreement shall be subject to the Commissioner's
			 approval. The group shall demonstrate to the Commissioner's satisfaction, on
			 the administrator's application form required by
			 211 CMR
			 67.06(2)(b)3., that any
			 administrator designated by the board of trustees is of good repute, is in
			 sound financial condition and is experienced in the area of workers'
			 compensation claims administration.
Code of Massachusetts Regulations › 211 CMR - DIVISION OF INSURANCE › Title 211 CMR 67.00 - Workers' Compensation Self-insurance Groups › Section 67.08 - Financial Standards and Reporting Requirements

Current through Register 1525, July 5, 2024
(1)
General
			 Provisions
.
(a) Except as set
			 forth in 211 CMR 67.08(2), and as may otherwise be established by the
			 Commissioner, a group shall follow the statutory accounting practices
			 prescribed by the National Association of Insurance Commissioners for all
			 property and liability insurance companies.
(b) As part of his or her authority to
			 examine groups under M.G.L. c. 152, § 25I, the Commissioner may elect to
			 obtain an independent analysis of a group's reserves, with expenses of such
			 analysis assessed against the group.
(c) After a group has been in operation for
			 three years, so long as a group has continued to meet the requirements of 211
			 CMR 67.08(2), the Commissioner may grant, upon petition of the group, a
			 reduction of the requirements applicable to the group that are set forth in 211
			 CMR 67.08(2)(d) and
			 67.21.
			 In reviewing a group's petition, the Commissioner may consider such financing
			 alternatives or insurance mechanisms proposed by the group. At the expense of
			 the group, the Commissioner may engage such financial, insurance or other
			 experts deemed necessary by the Commissioner to consider a petition submitted
			 by a group in accordance with 211 CMR 67.08.
(d) After a group has been in operation for
			 three years, the Commissioner may, for good cause, require an increase in the
			 requirements applicable to the group that are set forth in 211 CMR 67.08(2)(d)
			 and
			 67.21.
			 Such a required increase may be appealed to the Commissioner and may be altered
			 or revoked if the Commissioner finds, after notice and a hearing, that there
			 was not good cause to support such an increase.
Code of Massachusetts Regulations › 211 CMR - DIVISION OF INSURANCE › Title 211 CMR 67.00 - Workers' Compensation Self-insurance Groups › Section 67.10 - Reinsurance; Security Bond or Deposit; Fidelity Bond; Changes

Current through Register 1525, July 5, 2024
To maintain its certificate of approval, a group shall comply
				with the requirements of M.G.L. c.1 52,
				211 CMR 67.00, and any other
				applicable laws or regulations, and the following:
(1) Each group containing private employers
			 shall maintain a combined provable net worth as prescribed in
			 211 CMR
			 67.08(2)(c), but not less
			 than $1,000,000;
(2) Each group
			 containing private employers shall maintain a security bond or deposit in an
			 amount and form as prescribed in
			 211 CMR
			 67.08(2)(d), but not less
			 than $100,000;
(3) Each group shall
			 maintain specific and aggregate excess insurance or reinsurance in an amount
			 and form as prescribed in
			 211 CMR
			 67.21;
(4) Each group's administrator shall maintain
			 a fidelity bond in a form and amount as prescribed by
			 211 CMR
			 67.06(2)(b)9. and;
(5) Each group shall notify the Commissioner
			 of any change in the manner of its compliance with 211 CMR 67.10(1) through (4)
			 no later than 20 days after such change, including, but not limited to,
			 cancellation, nonrenewal or change in amount and terms of coverage of any
			 excess insurance, security bond or deposit or fidelity bond.
Code of Massachusetts Regulations › 211 CMR - DIVISION OF INSURANCE › Title 211 CMR 67.00 - Workers' Compensation Self-insurance Groups › Section 67.12 - Merger of Groups

Current through Register 1525, July 5, 2024
(1) Subject to the
			 prior written approval of the Commissioner, a group may merge with another
			 group engaged in the same or similar type of business only if the resulting
			 group assumes in full all obligations of the merging groups. A public employer
			 group may merge only with another public employer group.
(2) The resulting group may be a continuing
			 group under the name of one or more of the merged groups or a new group whose
			 name shall be subject to the Commissioner's approval. Groups merging under 211
			 CMR 67.12 shall enter into a written agreement for such merger prescribing its
			 terms and conditions. In all respects, the continuing group or the new group
			 shall be subject to the provisions of
			 211 CMR 67.00.
Such agreement shall be:
(a) assented to by a majority of the members
			 and the board of trustees of each group;
(b) executed in duplicate by a majority of
			 the board of each group;
(c)
			 accompanied by copies of the resolutions authorizing the merger and the
			 execution of the agreement attested to by the recording officer of each group;
			 and
(d) submitted to the
			 Commissioner, with the records of the companies pertaining thereto.
(e) approved, in writing, by the
			 Commissioner;
Code of Massachusetts Regulations › 211 CMR - DIVISION OF INSURANCE › Title 211 CMR 67.00 - Workers' Compensation Self-insurance Groups › Section 67.13 - Solicitation of Membership by Licensed Insurance Producers

Current through Register 1525, July 5, 2024
Except for the trustees, officers, directors or salaried
				employees of a group or its administrator, any person soliciting membership in
				a workers' compensation self-insurance group shall be a licensed insurance
				producer as provided by M.G.L. c. 175, § 1621.
Code of Massachusetts Regulations › 211 CMR - DIVISION OF INSURANCE › Title 211 CMR 67.00 - Workers' Compensation Self-insurance Groups › Section 67.14 - Deficiencies; Assessments; Liquidation of Groups

Current through Register 1525, July 5, 2024
(1) Every group's application and indemnity
			 agreement shall contain provisions providing for the following:
(a) in the event that a group incurs a fund
			 deficit in any fund year, such deficit shall be made up immediately with
			 surplus from a prior fund year or administrative funds, or the members of the
			 group shall be subject to automatic assessment without further action by the
			 group;
(b) in the event a member
			 fails to pay any premium, assessment, or other contribution to the group when
			 due, the members of the group shall be subject to automatic assessment without
			 further action by the group.
Code of Massachusetts Regulations › 211 CMR - DIVISION OF INSURANCE › Title 211 CMR 67.00 - Workers' Compensation Self-insurance Groups › Section 67.15 - Examination of Affairs, Transactions, Accounts, Records and Assets of Each Group

Current through Register 1525, July 5, 2024
The Commissioner shall examine the affairs, transactions,
				accounts, records and assets of each group and of the administrator of each
				group as often as the Commissioner considers advisable, but not less often than
				once every three years. The expense of such examinations shall be assessed
				against the group in the same amount and manner that insurers are assessed for
				examinations, pursuant to the provisions of M.G.L. c. 175, § 4 and M.G.L.
				c. 7, § 3B.
The Commissioner or his or her designee shall have free access
				to all the assets of the group for the purpose of verification and to all the
				books and papers relating to its business and to the books and papers of its
				representatives. The Commissioner or his or her designee may summon and examine
				under oath any person who, he or she believes, has knowledge of the affairs,
				transactions or circumstances being examined or investigated, and whoever
				without justifiable cause neglects upon due summons to appear and testify
				before the Commissioner or his or her authorized representative, and whoever
				obstructs the Commissioner or the representative in making examinations or
				investigations hereunder, shall be punished by a fine of not more than $1,000
				or by imprisonment for not more than one year.
Code of Massachusetts Regulations › 211 CMR - DIVISION OF INSURANCE › Title 211 CMR 67.00 - Workers' Compensation Self-insurance Groups › Section 67.16 - Termination of Certificate

Current through Register 1525, July 5, 2024
(1) The certificate
			 of approval issued by the Commissioner to a workers' compensation
			 self-insurance group authorizes the group to provide workers' compensation
			 coverage for members of the group. The certificate of approval remains in
			 effect until terminated at the request of the group or revoked by the
			 Commissioner pursuant to the provisions of
			 211 CMR
			 67.17. Termination of the certificate shall
			 not relieve either the group or its members of their duty to pay workers'
			 compensation benefits, nor shall it relieve members of their joint and several
			 liability to pay for claims incurred by the group during their period of
			 membership.
(2) The Commissioner
			 shall grant the request of any group to terminate its certificate of approval
			 provided the group has insured or reinsured all outstanding, both known and
			 unknown, workers' compensation obligations with a licensed insurer under an
			 agreement filed with and approved in writing by the Commissioner. Such
			 obligations shall include both known and unknown claims and the expenses
			 associated therewith.
Code of Massachusetts Regulations › 211 CMR - DIVISION OF INSURANCE › Title 211 CMR 67.00 - Workers' Compensation Self-insurance Groups › Section 67.17 - Revocation of Certificates of Approval

Current through Register 1525, July 5, 2024
(1)
			 After notice and opportunity for a hearing, the Commissioner may revoke a
			 group's certificate of approval if the group:
(a) is found to be insolvent;
(b) fails to pay any regulatory fee,
			 assessment, or special fund or trust fund contribution imposed on it under
			 M.G.L. c. 152, § 65;
(c) fails
			 to comply with any of the applicable provisions of
			 211 CMR 67.00, M.G.L. c. 152,
			 with any other applicable law or regulation, or with any lawful order of the
			 Commissioner.
Code of Massachusetts Regulations › 211 CMR - DIVISION OF INSURANCE › Title 211 CMR 67.00 - Workers' Compensation Self-insurance Groups › Section 67.18 - Misrepresentations or Omissions in Solicitations of Membership

Current through Register 1525, July 5, 2024
No person shall make a material misrepresentation or omission
				of a material fact in connection with the solicitation of a membership of a
				group. The Commissioner may take any appropriate action to enforce the
				provisions of 211 CMR 67.18.
Code of Massachusetts Regulations › 211 CMR - DIVISION OF INSURANCE › Title 211 CMR 67.00 - Workers' Compensation Self-insurance Groups › Section 67.19 - Affiliation of Administrators, Reinsurers, Claims Administrators, and Other Service Providers

Current through Register 1525, July 5, 2024
If the administrator or one of its affiliates wishes to provide
				reinsurance or excess insurance to a group, it shall use an independent third
				party to obtain at least two quotes from unaffiliated persons for those
				services. The third party shall present the two quotes, along with the quote
				from the administrator's affiliate, directly to the board of trustees, and the
				board shall choose which one to accept. The choice shall be solely at the
				discretion of the board and need not be the lowest bid. Reinsurance contracts
				with such affiliates shall be bid annually.
Code of Massachusetts Regulations › 211 CMR - DIVISION OF INSURANCE › Title 211 CMR 67.00 - Workers' Compensation Self-insurance Groups › Section 67.20 - Additional Provision Related to Existing Groups

Current through Register 1525, July 5, 2024
The security, net worth to premium, and reinsurance/excess
				insurance requirements, prescribed in
				211 CMR
				67.08(2)(c) and (d) and
				67.21,
				shall not apply to groups approved prior to January 1, 1993 until the later of
				the following dates, regardless of whether the group is in the middle of a fund
				year on such later date:
(1) January
			 1, 1995; or
(2) the third
			 anniversary of the date on which the group received its certificate of
			 approval.