reglab/statecodes huggingface dataset:
Code of Massachusetts Regulations › 804 CMR - MASSACHUSETTS COMMISSION AGAINST DISCRIMINATION › Title 804 CMR 12.00 - Fees For The Provision Of Commission Public Records › Section 12.02 - Definitions

Current through Register 1525, July 5, 2024
As used throughout 804 CMR 12.00, the following terms shall have the following meanings, unless the context clearly indicates otherwise:
Commission
means the Massachusetts Commission Against Discrimination.
Person
means any agency or political subdivision of the Federal government or the Commonwealth, or any state, public or private corporation or authority, any individual, trust, firm, joint stock company, partnership, association, or other entity, and any officer, employee or agent of said person, and any group of said persons.
Public Record
means any record made or received by any officer or employee of any agency, executive office, department, board, commission, bureau, division or authority of the Commonwealth, or of any authority established by the General Court to serve a public purpose, and which is a public record pursuant to M.G.L. c. 4, § 7, cl. 26, as may be amended from time to time.
Record
means a book, paper, map, photograph, recorded tape, financial statement, statistical tabulation, or any other documentary material or data, regardless of physical form or characteristics.
Code of Massachusetts Regulations › 804 CMR - MASSACHUSETTS COMMISSION AGAINST DISCRIMINATION › Title 804 CMR 12.00 - Fees For The Provision Of Commission Public Records › Section 12.03 - Processing Requests for Disclosure of Public Records

Current through Register 1525, July 5, 2024
In compliance with M.G.L. c. 66, § 10, the Commission shall, at reasonable times and without unreasonable delay, permit any person, under the supervision of Commission personnel, to inspect and examine any public record which is in the custody of the Commission and the Commission shall furnish one copy of such record on request and on payment of a reasonable fee. For purposes of 804 CMR 12.03, a "public record" shall not include any document exempted by M.G.L. c. 4, § 7, cl. 26, M.G.L. c. 151B, § 5, 804 CMR 1.04 or any other record specifically or by necessary implication exempted from disclosure by any other statute. Whenever a cost or fee is established or determined by the Commission, said cost or fee shall be paid to the Commission.
Code of Massachusetts Regulations › 804 CMR - MASSACHUSETTS COMMISSION AGAINST DISCRIMINATION › Title 804 CMR 12.00 - Fees For The Provision Of Commission Public Records › Section 12.04 - Established Fees

Current through Register 1525, July 5, 2024
(1) The following fees shall apply to any public record in the custody of the Commission:
(a) Preparing and mailing documents from a Commission complaint file: $10.00 for not more than seven pages plus .50¢ for each additional page.
(b) Self-service photocopies (where available): .25¢ per copy.
(c) Computer database search: $10.00 per query.
(d) Requests for records not associated with Commission complaints: based on an hourly rate of staff assigned to fulfill the request plus .25¢ per page.
(e) Digital reproductions of public hearing proceedings (where available): $25.00 per day of hearing.
Code of Massachusetts Regulations › 804 CMR - MASSACHUSETTS COMMISSION AGAINST DISCRIMINATION › Title 804 CMR 12.00 - Fees For The Provision Of Commission Public Records › Section 12.05 - Severability

Current through Register 1525, July 5, 2024
It is hereby declared that the provisions of 804 CMR 12.00 are severable, and if any provision hereof or the application thereof to any person or circumstance is held invalid, suchinvalidityshallnot affect other provisions hereof or applications thereof which can be given effect without the invalid provision or application.
Code of Massachusetts Regulations › 805 CMR - GROUP INSURANCE COMMISSION › Title 805 CMR 1.00 - General Provisions › Section 1.01 - Administrative Bulletins

Current through Register 1525, July 5, 2024
The Group Insurance Commission may issue administrative
				informational bulletins that provide the following:
(a) set out policies that are consistent with
			 the substantive provisions of the Commission's regulations;
(b) specify the information and documentation
			 necessary to implement the regulations;
(c) provide interpretations of the
			 regulations; and
(d) to assist
			 persons subject to the regulations to meet their obligations.
Code of Massachusetts Regulations › 805 CMR - GROUP INSURANCE COMMISSION › Title 805 CMR 1.00 - General Provisions › Section 1.03 - Severability

Current through Register 1525, July 5, 2024
The provisions of
				805 CMR
				1.00 through
				9.00 are severable. If any
				provision or the application of any provision is held to be invalid or
				unconstitutional, such invalidity shall not be construed to affect the validity
				or constitutionality of any remaining provisions of
				805 CMR
				1.00 or the application of such
				provisions.
Code of Massachusetts Regulations › 805 CMR - GROUP INSURANCE COMMISSION › Title 805 CMR 5.00 - MISCELLANEOUS › Section 5.01 - Relationship of Department Heads, the Commission and Employees

Current through Register 1525, July 5, 2024
The Commission has the exclusive responsibility to negotiate
				all contracts for benefits authorized by M.G.L. c. 32A, M.G.L. c. 32B,
				§§ 19 and 23, and accompanying regulations. Department heads,
				including agency heads, reporting location heads, and Group Insurance
				Coordinators are required to conduct all matters relating to Commission
				programs described in
				805 CMR
				5.00 with the Commission unless the Commission's
				Executive Director gives prior approval.
Code of Massachusetts Regulations › 805 CMR - GROUP INSURANCE COMMISSION › Title 805 CMR 5.00 - MISCELLANEOUS › Section 5.02 - Solicitation of Employees

Current through Register 1525, July 5, 2024
External persons and entities must obtain prior written
				approval of the Commission's Executive Director to discuss Commission matters
				with individual employees or groups of employees. If approval is given, group
				meetings or discussions shall only be conducted at the employees' workplace
				during duty hours and are subject to the department or agency head's prior
				approval.
(1) All informational
			 gatherings held for potential Municipal Insureds and Municipal Employers must
			 include representatives of all of the Commission's health plans that serve the
			 area to attend the gatherings to the extent that such meetings are attended by
			 any health plan representatives.
(2) Entities with Commission benefits must
			 offer to their employees, retirees, and survivors all such benefits for which
			 their Insureds are eligible, and may not offer competing benefits, except where
			 expressly authorized in statute. After written notice to the Commission,
			 Municipal Employers and Municipal Insureds who are considering withdrawal from
			 Commission Health Coverage may advertise for or solicit such plans or programs
			 in order to procure other health coverage after withdrawal.
(3) Health Plans, insurance carriers, agents,
			 brokers or representatives are prohibited from advertising to or soliciting any
			 benefit plans or programs to groups for whom the Commission is the exclusive
			 sponsor.
(4) Any person or entity
			 that the Commission determines has violated the provisions of 805 CMR 5.02
			 shall be ineligible to bid on Commission business for a period of up to five
			 years.
Code of Massachusetts Regulations › 805 CMR - GROUP INSURANCE COMMISSION › Title 805 CMR 5.00 - MISCELLANEOUS › Section 5.03 - Participation of Non-state Funded Employers Other than Municipal Employers

Current through Register 1525, July 5, 2024
Other than Municipal Employers, non-state funded employers
				whose employees, retirees, or survivors participate in Commission coverage as
				expressly mandated by state law shall directly reimburse the Commission for
				premium payments made on behalf of the employers' Insureds, together with a
				Commission fee. Reimbursing entities shall pay the Commission no later than 30
				days from the date of the Commission's invoice. The Commission may include in
				its Commission fee a charge determined by the State Comptroller for late
				payment. Such late charge shall be billed separately and identified on a
				subsequent Commission invoice. Monthly invoices are available through the
				Commission's eligibility system, MAGIC, and invoices must be reconciled to the
				payment submitted to the Commission. If the entity does not pay the invoice in
				full, the Commission will bill the entity for outstanding balances until full
				payment is made or discrepancies are reported and reconciled. Failure to remit
				full payment may result in cancellation of coverage for that entity's
				enrollees.
Code of Massachusetts Regulations › 805 CMR - GROUP INSURANCE COMMISSION › Title 805 CMR 5.00 - MISCELLANEOUS › Section 5.04 - Providers and Benefits

Current through Register 1525, July 5, 2024
(1) A
			 participating Nurse Practitioner operating within the scope of his or her
			 license, including all regulations requiring collaboration with a physician
			 under M.G.L. c. 112, § 80B, shall be considered qualified as primary care
			 providers for the Commissions' Insureds. Health Plans that fail to comply with
			 the law's provisions will be deemed a
prima facie
violation of
			 the Consumer Choice of Nurse Practitioner Services Act and a breach of its
			 contract with the Commission, subject to a fine or other such remedies as the
			 Commission determines to be reasonable.
(2) A participating Physician Assistant
			 operating within the scope of his or her license, including all regulations
			 requiring collaboration with a physician under M.G.L. c. 112, § 9E, shall
			 be considered qualified as primary care providers for the Commissions'
			 Insureds. Any Commission health plan that fails to comply with the provisions
			 of M.G.L. c. 176S will be deemed to have violated the Consumer Choice of
			 Physician Assistant Act and to have breached its contract with the Commission,
			 subject to a fine or other such remedies as the Commission determines to be
			 reasonable.
(3) Health plans that
			 require Insureds to designate a primary care provider shall provide clear and
			 concise information to Insureds that they may select a participating Nurse
			 Practitioner or Physician Assistant as a primary care provider or may change
			 their medical provider to a participating Nurse Practitioner or Physician
			 Assistant. Insureds' Evidence of Coverage shall also contain a clear, concise
			 and complete statement that the carrier will provide benefit coverage to
			 subscribers on a Nondiscriminatory Basis for covered services when delivered or
			 arranged for by a participating Nurse Practitioner or Physician
			 Assistant.
(4) Notwithstanding any
			 general or special law to the contrary, the Commission's health plans shall
			 include and make available to Insureds the same type of information about
			 participating Nurse Practitioners or Physician Assistants as they provide about
			 their participating physicians, and shall display the participating Nurse
			 Practitioner and Physician Assistant information in the same manner and format
			 as they do for their participating physicians.
Code of Massachusetts Regulations › 805 CMR - GROUP INSURANCE COMMISSION › Title 805 CMR 5.00 - MISCELLANEOUS › Section 5.05 - Failure to Report

Current through Register 1525, July 5, 2024
Other than Municipal Employers who are addressed in
				805 CMR
				8.02(5), an employer whose
				employees, retirees, or survivors participate in Commission coverage that fails
				repeatedly or egregiously to notify the Commission within 60 days of a
				termination or other loss of eligibility due to a change in employment status,
				the Commission may assess against the employer a financial penalty of $100 per
				ineligible person per month, or the amount by which actual claims for any
				ineligible person exceeded premiums paid by the employer for that person,
				whichever is greater.
Code of Massachusetts Regulations › 805 CMR - GROUP INSURANCE COMMISSION › Title 805 CMR 7.00 - Subdivision › Section 7.01 - Retired Municipal Teachers: In General

Current through Register 1525, July 5, 2024
(1) A
			 Local Governmental Unit that accepts M.G.L. c. 32B, § 11E shall inform the
			 Commission in writing of its decision to transfer its retired teachers to the
			 Commission's Health Coverage for Retired Municipal Teachers.
(2) Upon receiving the Local Governmental
			 Unit's acceptance notice, the Commission shall consider applications from the
			 Local Governmental Unit and shall notify the Local Governmental Unit's
			 treasurer that the Commission has approved the coverage transfer. Thereafter,
			 the Local Governmental Unit shall promptly notify all teachers whom it employs
			 that they must be enrolled in the Local Governmental Unit's basic life
			 insurance upon retirement in order to be eligible for the Commission's life
			 insurance and Retired Municipal Teacher health coverage.
(3) Eligible retiring teachers or their
			 surviving spouses, as applicable, who apply when first eligible to be insured
			 in the Retired Municipal Teachers' Program, must complete a Commission
			 application in order to avoid a lapse in coverage. Teachers shall complete and
			 submit their applications to the Commission approximately three months before
			 their anticipated Coverage effective date determined by the
			 Commission.
(4)
(a) Retiring teachers whose Local
			 Governmental Unit participates in the Commission's Retired Municipal Teacher
			 program are required to be insured with the Local Governmental Unit upon
			 Retirement in order to be eligible for Commission coverage.
(b) The Local Governmental Unit providing
			 Retired Municipal Teacher coverage shall provide a notice to all newly hired
			 teachers informing them that they must be enrolled in the Local Governmental
			 Unit's life or life and health coverage at retirement in order to be eligible
			 for Retired Municipal Teacher coverage. The Local Governmental Unit shall allow
			 teachers who have a right to retire but defer their retirement to maintain
			 their eligibility by continuing to be insured for Basic Life Insurance or Basic
			 Life and Health Insurance.
Code of Massachusetts Regulations › 805 CMR - GROUP INSURANCE COMMISSION › Title 805 CMR 7.00 - Subdivision › Section 7.02 - Transfer Procedures, Effective Date of Insurance

Current through Register 1525, July 5, 2024
(1) The Commission shall contact retiring
			 teachers about their applications for Retired Municipal Teacher coverage, and
			 shall determine their effective dates of coverage. The Local Governmental Unit
			 shall continue to be responsible for providing the retiring teachers' premium
			 contributions to their Local Government Unit coverage until such time as their
			 Retired Municipal Teacher coverage becomes effective.
(2) The Local Government Unit must process
			 Retired Municipal Teacher coverage as follows:
(a) The Local Governmental Unit shall
			 continue to collect premium payment from the retired teachers or their
			 surviving spouses, as applicable, until the Commission sends notice that
			 premium payment has been transferred to pension deduction.
(b) The Local Governmental Unit shall furnish
			 Commission applications to all retiring teachers who, at the time of
			 retirement, are enrolled in life insurance coverage or life and health
			 insurance coverage, along with the notice described in
			 805 CMR
			 7.01(2), three months prior
			 to their expected retirement date.
(c) The Local Governmental Unit shall
			 continue to collect retiring teachers' premium for two Calendar Months
			 following the month in which the teacher retires. The first day of the third
			 Calendar Month following the month in which a teacher retires, or a date
			 otherwise determined by the Commission, is the retired teacher's coverage
			 effective date, provided that the retiree pays the required monthly premium for
			 coverage. The Commission shall notify the Local Governmental Unit of all
			 retirees' effective dates of Commission coverage.
Code of Massachusetts Regulations › 805 CMR - GROUP INSURANCE COMMISSION › Title 805 CMR 7.00 - Subdivision › Section 7.03 - Correction of Incorrect Premium Payment

Current through Register 1525, July 5, 2024
(1)
			 If a Local Governmental Unit continues to bill a retiring teacher and also
			 receives premium payment after the retiring teacher's effective date of
			 Commission coverage, the Local Governmental Unit shall refund the payment to
			 the retiring teacher upon satisfactory proof of payment.
(2) If a Local Governmental Unit ceases
			 billing a retiring teacher before his or her Retired Municipal Teacher's
			 coverage effective date, creating a premium payment lapse, the Local
			 Governmental Unit shall bill the teacher for past and current premium due until
			 the Commission notifies the Local Governmental Unit to discontinue
			 billing.
(3) If the Commission's
			 premium is not deducted from the retiring teacher's pension or annuity, the
			 Commission shall bill the teacher directly until the premium has been deducted.
			 Failure to pay the required premium on time shall result in termination of
			 coverage.
Code of Massachusetts Regulations › 805 CMR - GROUP INSURANCE COMMISSION › Title 805 CMR 7.00 - Subdivision › Section 7.05 - Termination of Retired Municipal Teacher Status

Current through Register 1525, July 5, 2024
(1) If the Local Governmental Unit
			 subsequently withdraws from Commission coverage, all Retired Municipal Teachers
			 will cease to be eligible for the Commission's Retired Municipal Teacher
			 coverage. The Commission and the Local Governmental Unit shall jointly
			 determine the termination effective date.
(2) Retired Municipal Teachers whose Local
			 Governmental Unit agrees to join the Commission's Health Coverage pursuant to
			 M.G.L. c. 32B, § 19 cease to be Retired Municipal Teachers and, in so
			 doing, their Commission's Basic Life Insurance and Retiree Dental Coverage ends
			 on the date on which the Municipal Employer joins the Commission's Health
			 Coverage.
(3) A Local Governmental
			 Unit that decides to join Health Coverage pursuant to M.G.L. c. 32B, § 19
			 must continue to contribute its premium share to Retired Municipal Teacher
			 coverage until the date that all of the Local Governmental Unit's insureds
			 begin their Health Coverage.
Code of Massachusetts Regulations › 805 CMR - GROUP INSURANCE COMMISSION › Title 805 CMR 8.00 - MUNICIPAL HEALTH COVERAGE › Section 8.01 - Transfer Procedures

Current through Register 1525, July 5, 2024
The Commission shall determine whether a Municipal Employer
				that has adopted M.G.L. c. 32B, § 19 or 23, qualifies for the Commission's
				Health Coverage. If the Commission approves a Municipal Employer to transfer
				all of its Insureds whom the Commission determines to be eligible to join the
				Commission's Health Coverage, it shall do so according to the conditions set
				forth in M.G.L. c. 32B, §§ 19, 21, and 23.
(1)
Notice
.
			 Non-unionized cities, town and districts must send a letter from their chief
			 executive officer stating their decision to transfer the Municipal Employer's
			 subscribers to Commission coverage. Unionized Municipal Employers must provide
			 notice as follows:
(a)
Section 19
			 Notice
. For the purposes of notice to the Commission of intent to
			 transfer subscribers sufficient to satisfy M.G.L. c. 32B, § 19(e),
			 Unionized Municipal Employers must provide to the Commission a copy of the
			 signed and executed Public Employee Committee agreement to join the
			 Commission's health coverage and a cover letter from an authorized official of
			 the Municipal Employer confirming the Municipal Employer's intent to join
			 Commission Health Coverage. The notice deadline may be extended up to a maximum
			 of five business days after the statutory deadline for the sole purpose of
			 executing the Public Employee Committee agreements.
(b)
Section 23
			 Notice
. For the purposes of notice to the Commission of intent to
			 transfer subscribers sufficient to satisfy M.G.L. c. 32B, § 23(a),
			 Unionized Municipal Employers must provide to the Commission a copy of the
			 signed and executed Public Employee Committee agreement, or the order of the
			 three-person panel, under M.G.L. c. 32B, § 21, to join the Commission's
			 health coverage, a copy of the proposal underlying the order of the
			 three-person panel, where applicable, and a cover letter from an authorized
			 official of the Municipal Employer that gives notice of a decision to transfer
			 to the Commission. The agreement or the order and supporting proposal shall
			 include the premium contribution details.
Code of Massachusetts Regulations › 805 CMR - GROUP INSURANCE COMMISSION › Title 805 CMR 8.00 - MUNICIPAL HEALTH COVERAGE › Section 8.03 - Eligibility, Conditions of Participation

Current through Register 1525, July 5, 2024
(1) To be eligible for Health Coverage,
			 persons affiliated with Municipal Employers must be Employees, Retirees,
			 Survivors, or Dependents, as those terms are defined in
			 805 CMR 1.02:
Definitions
.
(2)
			 For the purposes of implementing M.G.L. c. 32B, §§ 19 and 23, the
			 Commission interprets M.G.L. c. 32B, §§ 19(a) and (e) and 23(h) to
			 mean that eligibility for Health Coverage in political subdivisions that have
			 transferred subscribers to the Commission pursuant to M.G.L. c. 32B, § 19
			 or 23 remains subject to M.G.L. c. 32B. However, for those political
			 subdivisions, the Commission is the sole determinant of who is eligible for
			 Health Coverage. The Commission interprets eligibility under M.G.L. c. 32B to
			 be the same as eligibility under M.G.L. c. 32A, except where there is a clear
			 distinction between the two chapters. Therefore:
(a) Consistent with
			 805
			 CMR 9.08:
Employees and Municipal
			 Insureds not Entitled to Receive a Pension or Retirement Allowance
and
			 805 CMR 1.02:
Employee
and
Retiree
, the
			 employees and retirees of a city, town, regional school district, or any other
			 statutorily authorized district shall not be eligible for Commission coverage
			 unless they are members of a Massachusetts public sector retirement system, are
			 receiving a pension from a public retirement system, or are Survivors of
			 Municipal Employees or Retirees (OBRA is not such a public retirement system
			 for this purpose).
(b) Municipal
			 Employees, except elected officials or others as expressly exempted by law,
			 must meet the requirement of a Regular Work Week, as defined in
			 805 CMR 1.02:
Definitions
. For the purposes of M.G.L. c. 32B, §§
			 19 and 23, the reference to "20 hours" in M.G.L. c. 32B, § 2, "Employee"
			 means 20 hours out of a regular work week of 40 hours, or 18.75 hours out of a
			 regular work week of 37.5 hours.
Code of Massachusetts Regulations › 805 CMR - GROUP INSURANCE COMMISSION › Title 805 CMR 8.00 - MUNICIPAL HEALTH COVERAGE › Section 8.04 - Coverage Continuation and Termination, Notice Deadline

Current through Register 1525, July 5, 2024
(1) A Municipal Employer that transfers to
			 Health Coverage due to a Fiscal Emergency declared by the Legislature may
			 continue Health Coverage for its insureds after the governing finance control
			 board or receiver determines that a Fiscal Emergency no longer exists or
			 otherwise ends its oversight of the Municipal Employer. If a Municipal Employer
			 remains in Health Coverage after release from finance control board oversight,
			 the Municipal Insureds' Health Coverage shall be subject to the same Commission
			 rules and regulations that apply to Municipal Employers whose Insureds have
			 joined Health Coverage pursuant to M.G.L. c. 32B, § 19.
(2) If a Municipal Employer terminates
			 Commission coverage without giving notice by the deadline, the Municipal
			 Insureds' Health Coverage shall be cancelled for nonpayment retroactive to the
			 last month for which the Municipal Employer paid its share of the
			 premium.
(3) A Municipal Employer
			 transferring out of the Commission's coverage pursuant to M.G.L. c. 32B, §
			 19 or 23 shall provide the Commission with notice on or before December
			 1st for transfer on July
			 1st of the following year. The effective date for a
			 Municipal Employer to withdraw from Commission coverage shall be on July
			 1st of the expiration year as specified in a
			 municipal entity's bargained agreement or Order of the Panel, and Commission
			 coverage shall end on June 30th.
(4) A Municipal Employer that withdraws from
			 Commission coverage and does not immediately transfer its Insureds to the
			 Commission pursuant to a different section of M.G.L. c. 32B may not transfer
			 its Insureds to the Commission for three years. For example, a Municipal
			 Employer may withdraw from Commission coverage pursuant to M.G.L. c. 32B,
			 § 19 effective July 1st and transfer its
			 Insureds to Commission coverage pursuant to M.G.L. c. 32B, § 23, as of the
			 same July 1st. However, if it does not do so, but
			 instead withdraws from all Commission coverage, it may transfer its Insureds
			 once again to the Commission no earlier than July
			 1st, three years after the effective date of the
			 earlier withdrawal.
(5) A Municipal
			 Employer that fails to notify the Commission of its transfer decision as
			 specified in 805 CMR 8.04(3) and fails to provide the Commission with a new PEC
			 agreement by the expiration of its then current PEC agreement shall be
			 re-enrolled for the minimum renewal period specified in M.G.L. c. 32B, §
			 19 or 23. The contribution ratios specified in M.G.L. c. 32B, § 19
			 expiring PEC agreement will continue until a successor agreement is provided to
			 the Commission.
Code of Massachusetts Regulations › 805 CMR - GROUP INSURANCE COMMISSION › Title 805 CMR 8.00 - MUNICIPAL HEALTH COVERAGE › Section 8.07 - Commonwealth Charter Schools, Education Collaboratives, Regional Planning Agencies, and Regional Councils of Government

Current through Register 1525, July 5, 2024
(1)
Eligibility
.
			 Employees, Retirees, Survivors, and Dependents of Commonwealth charter schools,
			 education collaboratives, regional planning agencies, or regional councils of
			 government are eligible for Commission benefits if they are statutorily
			 entitled to such benefits pursuant to M.L. c. 32A, § 2(b), or if the
			 Commonwealth charter school, education collaborative, regional planning agency,
			 or regional council of government has adopted M.G.L. c. 32A as specified in
			 M.G.L. c. 32A, § 2(b), M.G.L. c. 32A, § 3B, or M.G.L. c. 32B, §
			 21(a), whichever is applicable.
(2)
Notice
. Non-unionized Commonwealth charter schools
			 must provide a certified copy of the majority vote of their board of trustees
			 to join Commission health coverage; non-unionized education collaboratives must
			 provide a certified copy of their boards of directors' majority vote to join
			 Commission coverage. Regional planning agencies and regional councils of
			 government must provide a letter from their governing board stating their
			 decision to join Commission coverage. Unionized Commonwealth charter schools
			 and unionized educational collaboratives must provide the Commission with
			 notice of intent to transfer as required by M.G.L. c. 32B, § 19 or §
			 23.
(3) Commonwealth charter
			 schools, education collaboratives, regional planning agencies, or regional
			 councils of government shall follow the transfer protocols in
			 805 CMR
			 8.01.
(4)
Terms
. Except as
			 otherwise stated in
			 805 CMR
			 8.06, Commonwealth charter schools, education
			 collaboratives, regional planning agencies, or regional councils of government
			 who opt to join Commission coverage are subject to applicable requirements of
			 M.G.L. c. 32A and related regulations.
Code of Massachusetts Regulations › 805 CMR - GROUP INSURANCE COMMISSION › Title 805 CMR 9.00 - ELIGIBILITY AND PARTICIPATION › Section 9.02 - Elected Officials

Current through Register 1525, July 5, 2024
(1) Officials elected by popular vote are
			 eligible for coverage on the first day of the month nearest the date that they
			 begin their term of office, excepted as noted in
			 805
			 CMR 9.02(2). Appointed
			 employees and officials are subject to the waiting period for coverage in
			 805
			 CMR 9.01(3).
(2) Elected officials who are Municipal
			 Employees and who have a Regular Work Week of less than 18.75 hours are
			 eligible for coverage only at local option, per M.G.L. c. 32B, § 2(d),
			 "Employee". Municipal Employers shall inform the Commission by May
			 1st of each year of any change in eligibility of
			 elected officials. Notification of the local option is binding on the Municipal
			 Employer for the fiscal year starting that July
			 1st.
Code of Massachusetts Regulations › 805 CMR - GROUP INSURANCE COMMISSION › Title 805 CMR 9.00 - ELIGIBILITY AND PARTICIPATION › Section 9.03 - Eligibility for Health Coverage

Current through Register 1525, July 5, 2024
(1)
			 Municipal Insureds, Survivors, and Elderly Governmental Retirees are eligible
			 to enroll in Health Coverage without electing any other benefit. All other
			 Employees and Retirees, including Retired Municipal Teachers must be enrolled
			 in Basic Life Insurance in order to be eligible for Health Coverage.
(2) Persons who cancel their Medicare
			 coverage will next be eligible for the Commission's Health Coverage on July
			 1st after they reapply for Medicare and are
			 reinstated to Medicare coverage. Commonwealth Retirees shall be solely
			 responsible for any Medicare penalties incurred by the cancellation.
(3) During any of the Commission's Annual
			 Enrollment periods, uninsured Employees, Retirees and Survivors may elect
			 Commission health coverage, which shall become effective the next occurring
			 July 1st.
(4) Employees, Retirees, Survivors, and
			 Dependents may enroll in Commission health coverage if they provide acceptable
			 proof of loss of other coverage and are otherwise eligible for the coverage.
			 The Commission shall determine the effective date of coverage.
(5) Employees, Retirees, and Survivors who
			 terminate coverage due to non-payment of premiums may re-apply during any of
			 the Commission's Annual Enrollment periods, provided they are otherwise
			 eligible for coverage.
(6) The
			 Commission shall determine the effective date for all matters pertaining to
			 Health Coverage including, but not limited to, eligibility, effective dates of
			 coverage, termination, and status changes. The Commission determines whether
			 persons are eligible for Commission coverage according to M.G.L. c. 32A and c.
			 32B, and its eligibility decisions are final and binding.
Code of Massachusetts Regulations › 805 CMR - GROUP INSURANCE COMMISSION › Title 805 CMR 9.00 - ELIGIBILITY AND PARTICIPATION › Section 9.05 - Duplicate Coverage Prohibited

Current through Register 1525, July 5, 2024
(1) In the event that a person is eligible
			 for Commission benefits as an Employee or Retiree of more than one Employer, or
			 as more than one of the following categories: Employee, Retiree, and Dependent;
			 the person must elect a single such status for the purposes of enrolling in
			 Commission benefits. For example, a person who qualifies both as a State
			 Retiree and as a Municipal Employee may elect to be treated as either one, but
			 not both.
(2) If both members of a
			 married couple are Employees or Retirees and both are enrolled in Commission
			 coverage, they may either:
(a) each have
			 Individual Health Coverage; or
(b)
			 have Family Health Coverage covering both spouses and all other eligible
			 Dependents. If a couple elects Family Health Coverage, only one spouse of the
			 couple may be the named Insured for the Family Coverage. Both Employee spouses
			 and dependents may enroll in other GIC benefits for which they may be eligible,
			 for example both employees or retirees may each enroll in Basic Life Insurance
			 coverage.
Code of Massachusetts Regulations › 805 CMR - GROUP INSURANCE COMMISSION › Title 805 CMR 9.00 - ELIGIBILITY AND PARTICIPATION › Section 9.07 - Subsequent Determination of Ineligibility

Current through Register 1525, July 5, 2024
If premiums have been paid and accepted on behalf of a person
				enrolled in Commission coverage and the Commission later determines that the
				person was not eligible, Commission coverage shall cease either as provided by
				law or as of the end of the period for which the Commission last received
				premium payment. The ineligible person shall not be entitled to continuation
				coverage except as required by federal law.
If an employee initially is eligible and insured under the
				Commission's programs but thereafter becomes ineligible due to a change in
				employment or status in the service of the Commonwealth or of one of its
				participating municipalities, his or her Commission coverage shall terminate at
				the end of the month following the month in which the change that caused the
				Employee's ineligibility occurs or a later date as determined by the
				Commission. Such employees shall be entitled to Continuation Coverage, unless
				the ineligibility is due to termination for gross misconduct.
If an employee or covered person becomes ineligible by
				operation of law, coverage shall terminate on the date they become ineligible.
				The ineligible person shall be entitled to continuation coverage only as
				required by state or federal law.
Code of Massachusetts Regulations › 805 CMR - GROUP INSURANCE COMMISSION › Title 805 CMR 9.00 - ELIGIBILITY AND PARTICIPATION › Section 9.08 - Employees Not Entitled to Receive a Pension or Retirement Allowance

Current through Register 1525, July 5, 2024
Employees who are not entitled to receive a pension or a
				retirement allowance when they terminate employment or who subsequently lose or
				withdraw their pension after retirement are not eligible to continue Commission
				Coverage. However, Employees other than Municipal Employees may be entitled to
				Commission life insurance portability or conversion and health insurance
				Continuation Coverage as set forth in
				805
				CMR 9.13 and
				9.14;
				Municipal Employees and their Dependents may be eligible for health insurance
				Continuation Coverage as set forth in
				805
				CMR 9.13 and
				9.14.
Code of Massachusetts Regulations › 805 CMR - GROUP INSURANCE COMMISSION › Title 805 CMR 9.00 - ELIGIBILITY AND PARTICIPATION › Section 9.09 - Surviving Spouses

Current through Register 1525, July 5, 2024
Surviving Spouses may elect to remain insured only for Health
				coverage until their remarriage or death. They must apply for Surviving Spouse
				coverage within six months of the Employee's or Retiree's death. Additional
				time to apply may be granted for delays due to the applicant's medical
				condition or the existence of other coverage that has since terminated.
(1) Surviving Spouses of deceased Employees
			 or Retirees who were enrolled in Commission Coverage at the time of the
			 Insureds' death may elect only Health Coverage until their remarriage or death.
			 Surviving Spouses must apply for Surviving Spouse Health Coverage.
(2) Surviving Spouses who are eligible for
			 coverage as Employees are not eligible for survivor coverage, unless they
			 terminate employment. Persons who are eligible for coverage as Retirees are not
			 eligible for survivor coverage.
(3)
			 Divorced or legally Separated Spouses are not Surviving Spouses and are not
			 eligible for Surviving Spouse coverage.
(4) Surviving Spouses who receive a
			 retirement allowance must have their Health Coverage premium deducted from
			 their retirement allowance.
(5)
			 Widows and widowers of deceased Insureds are only eligible for Surviving Spouse
			 coverage if the deceased was enrolled in Commission coverage at the time of
			 death.
Code of Massachusetts Regulations › 805 CMR - GROUP INSURANCE COMMISSION › Title 805 CMR 9.00 - ELIGIBILITY AND PARTICIPATION › Section 9.10 - Surviving Dependents

Current through Register 1525, July 5, 2024
Surviving Dependents may elect Health Coverage until the
				Surviving Dependent becomes eligible to enroll in other group health coverage
				or becomes 26 years of age, whichever occurs first. Surviving Dependents must
				apply for Health Coverage within six months of the Employee's or Retiree's
				death. For good cause shown, the Commission may grant additional time to
				apply.
Code of Massachusetts Regulations › 805 CMR - GROUP INSURANCE COMMISSION › Title 805 CMR 9.00 - ELIGIBILITY AND PARTICIPATION › Section 9.13 - Conversion of Health Coverage: Continuation Coverage Options

Current through Register 1525, July 5, 2024
(1) Insured
			 Employees in good premium standing who terminate their employment and whose
			 Dependents become ineligible for Commission Health Coverage may convert their
			 Health Coverage to non-group conversion or continuation Health Coverage,
			 including Federal "COBRA" coverage, and Massachusetts Health Connector
			 Authority coverage, provided that they apply for health coverage 31 days
			 following the later of:
(a) termination of
			 Family Health Coverage; or
(b) the
			 date that the former health plan or the Commission notifies the former Employee
			 of his or her right to obtain non-group coverage, provided that the Employee is
			 in good premium payment standing on the date of his or her group Health
			 Coverage termination.
Code of Massachusetts Regulations › 805 CMR - GROUP INSURANCE COMMISSION › Title 805 CMR 9.00 - ELIGIBILITY AND PARTICIPATION › Section 9.14 - Conversion of Life Insurance: Continuation Coverage Options

Current through Register 1525, July 5, 2024
Insured Employees who leave employment or become ineligible for
				Commission coverage due to a reduction in hours may either apply for portable
				group term life insurance similar to their Commission life insurance or may
				convert their life insurance to a non-group life insurance plan with the
				carrier providing Commission life insurance coverage when the Commission
				coverage ends without having to provide medical evidence of insurability.
				Employees must apply to the group life insurance carrier for portable life
				insurance coverage within 31 days of terminating Commission coverage and pay
				the first month's premium within 31 days of the date of the carrier's premium
				bill or within 15 days of the date the notice of conversion right is sent to
				the employee. Employees applying for non-group conversion coverage must do so
				within 90 days of the Commission's coverage termination. Only applicants in
				good premium standing when terminating their employment can be considered for
				continued coverage.
Code of Massachusetts Regulations › 805 CMR - GROUP INSURANCE COMMISSION › Title 805 CMR 9.00 - ELIGIBILITY AND PARTICIPATION › Section 9.15 - Misstatement of Information and Misuse of Benefit Plans

Current through Register 1525, July 5, 2024
(1) An Insured's
			 coverage may be terminated, in addition to other civil or criminal penalties,
			 if the Commission determines that the Insured provided incorrect information in
			 submitting a medical evidence of insurability or other such form that resulted
			 in approval of the Insured's coverage request. The Commission shall establish
			 the extent and duration of the termination.
(2) Any Insured who procures services
			 fraudulently or submits false claims for himself or herself, or otherwise
			 enables a person who is not eligible for Commission coverage to fraudulently
			 enroll, procure services for, or submit claims for Commission coverage shall,
			 upon determination by the Commission and, in addition to other civil or
			 criminal penalties that may be imposed, forfeit his or her eligibility for
			 Commission coverage. The Commission shall establish the extent and duration of
			 the forfeiture.
(3) Personal
			 reimbursement of out-of-country health care claims will only be provided to
			 Insureds who produce all related records requested by the plan and, as
			 necessary, their translation; an itemized bill for health care claimed and, as
			 necessary, its translation; and satisfactory proof of personal payment of the
			 claims by cancelled check or credit card statement. Reimbursement is subject to
			 the reasonable and customary payment as determined by the health plan, based on
			 the locality where services were rendered.
Code of Massachusetts Regulations › 805 CMR - GROUP INSURANCE COMMISSION › Title 805 CMR 9.00 - ELIGIBILITY AND PARTICIPATION › Section 9.16 - Retired National Guard Technicians

Current through Register 1525, July 5, 2024
(1) National Guard
			 Technicians retired after January 1, 1969 who receive a pension from the State
			 Retirement System may become insured as Retirees, notwithstanding the period of
			 time from January 1, 1969 to their retirement when they were Federal employees,
			 provided that they were insured on the date of transfer from the state
			 employment to federal employment.
(a) Such
			 National Guard Technicians must complete an application for Commission
			 coverage.
(b) The application for
			 coverage must be received by the Commission within 31 days following the date
			 of retirement. Persons who fail to submit a timely application may reapply at
			 the Commission's next occurring Annual Enrollment.
Code of Massachusetts Regulations › 805 CMR - GROUP INSURANCE COMMISSION › Title 805 CMR 9.00 - ELIGIBILITY AND PARTICIPATION › Section 9.17 - Surviving Spouses of National Guard Technicians

Current through Register 1525, July 5, 2024
(1) Surviving
			 spouses of insured Retired National Guard Technicians may be insured for health
			 insurance only.
(2) Surviving
			 spouses of Retired National Guard Technicians who were federal employees at the
			 time of death may be insured for health insurance only, provided that such
			 National Guard Technicians were insured by the Commission on the date of their
			 transfer from state employment to federal employment.
Code of Massachusetts Regulations › 805 CMR - GROUP INSURANCE COMMISSION › Title 805 CMR 9.00 - ELIGIBILITY AND PARTICIPATION › Section 9.18 - Retired Employees' Return to Active Employment

Current through Register 1525, July 5, 2024
Retirees who subsequently are hired for a position with
				benefits by the Commonwealth or a Municipal Employer may either continue their
				Commission coverage as active employees if they waive their monthly retirement
				allowance, or may continue to have their retiree premium deducted from their
				retirement allowance.
Code of Massachusetts Regulations › 805 CMR - GROUP INSURANCE COMMISSION › Title 805 CMR 9.00 - ELIGIBILITY AND PARTICIPATION › Section 9.19 - Reemployed Persons

Current through Register 1525, July 5, 2024
(1) Insured Employees who terminate
			 employment while in good premium payment standing, who are rehired as Employees
			 in a position with benefits and begin employment before Commission coverage
			 ends under their prior public employment, shall continue to be insured without
			 a break in existing coverage, provided that they submit a timely application
			 for Commission coverage.
(2)
			 Insured Employees who terminate employment while in good premium payment
			 standing and are rehired as State Employees after their Commission coverage
			 ends shall be insured as new Employees and will be subject to the New Employee
			 waiting period for Commission coverage.
Notwithstanding
				805
				CMR 9.19(2), Insured State
				Employees who terminate employment while in good premium payment standing and
				are rehired as State Employees in a position with benefits within two years of
				the date of termination of their employment shall be considered to have been
				hired on their original hire date for the purposes of computing the
				Commonwealth's share of their premiums. The employee is responsible for
				ensuring their premium contribution is correct based on their original hire
				date. The Commission will not reimburse premium differentials that occurred
				prior to notification to the Commission of an incorrect premium
				contribution.
(3) In the
			 event that an Insured Employee is reinstated in a prior position as the outcome
			 of a labor arbitration or other statutory labor proceeding, a Massachusetts
			 Commission Against Discrimination (MCAD) proceeding, operation of M.G.L. c. 30,
			 § 59, or court order, such employee shall be considered to have been hired
			 on his or her original hire date for the purposes of computing the
			 Commonwealth's share of premiums. Benefits as an active State Employee will be
			 reinstated prospectively as soon as is administratively feasible, without
			 waiting for the next Annual Enrollment period, provided GIC receives the
			 arbitration agreement or court order within 60 days of rehire. Evidence of
			 Insurability will be required for Long Term Disability and Optional Life
			 Insurance.
Code of Massachusetts Regulations › 805 CMR - GROUP INSURANCE COMMISSION › Title 805 CMR 9.00 - ELIGIBILITY AND PARTICIPATION › Section 9.20 - Retirement - General

Current through Register 1525, July 5, 2024
(1) Retirees entitled to a pension or
			 retirement allowance may continue Basic Life and Health Insurance coverage, and
			 Additional Life Insurance by applying to continue the coverage and continue
			 paying the required premium. State Retirees, Retired Municipal Teachers, and
			 eligible Municipal Retirees may also enroll in the Commission's retiree dental
			 coverage by submitting an enrollment application in a time frame as determined
			 by the Commission. The retiree must be receiving a monthly pension allowance
			 and authorize premiums to be paid
via
pension deduction to be
			 eligible to continue Commission benefits. When there is a delay in pension
			 payments, the Commission will consider the applicant a Deferred Retiree under
			 805
			 CMR 9.20(5).
(2) State Retirees who never have been
			 insured through the Commission and initially apply for Commission coverage as
			 State Retirees are eligible to apply for the Commission's Retiree Basic Life,
			 Health Coverage, and Retiree Dental Coverage. Coverage applications may be made
			 with a valid qualifying event or during annual enrollment. The retiree must be
			 receiving a monthly pension allowance to apply for benefits. The effective date
			 of coverage shall be determined by the Commission.
(3) Retirees who are rehired as an Employee
			 under the applicable provisions of M.G.L. c. 32 and are receiving adjusted
			 salary or wages are not eligible to be insured as an active Employee. Retirees
			 who waive and renounce their rights to all pension or retirement allowance
			 payable to them for a period of time in accordance with M.G.L. c. 32, and are
			 not rehired as full-time Employees for a period of time that does not
			 constitute Emergency Employment, may be insured as an active Employee subject
			 to payment of the Employee's share of the premium.
(4) Eligible Retirees who voluntarily
			 withdraw from Basic Life or Basic Life and Health Coverage may apply to
			 reenroll in Commission coverage either during the next Annual Enrollment or if
			 they provide acceptable proof of loss of other coverage.
(5) Deferred Retirees are considered to be
			 Employees on leaves of absence without pay for as long as they retain the right
			 to receive a retirement allowance from a participating retirement system and do
			 not withdraw their pension monies from the retirement system. Persons receiving
			 a retirement allowance cease to be Deferred Retirees.
(6) Once a Retiree enrolls in a health plan,
			 the next opportunity to change plans is the GIC's next Annual Enrollment
			 period, except as otherwise required by law.