reglab/statecodes huggingface dataset:
Code of Massachusetts Regulations › 211 CMR - DIVISION OF INSURANCE › Title 211 CMR 67.00 - Workers' Compensation Self-insurance Groups › Section 67.22 - Cease and Desist Orders

Current through Register 1525, July 5, 2024
After notice and opportunity for hearing, the Commissioner may
				issue an order requiring a person or group to stop engaging in an act or
				practice found to be in violation of any provision of
				211 CMR 67.00, M.G.L. c. 152,
				or any other applicable law or regulation.
Upon a finding, after notice and opportunity for a hearing,
				that any person or group has violated any cease and desist order, the
				Commissioner may impose a monetary penalty of not more than $10,000 for each
				act or violation of such order, not to exceed an aggregate monetary penalty of
				$100,000, and may revoke the group's certificate of approval.
Code of Massachusetts Regulations › 211 CMR - DIVISION OF INSURANCE › Title 211 CMR 67.00 - Workers' Compensation Self-insurance Groups › Section 67.23 - Penalties

Current through Register 1525, July 5, 2024
After notice and opportunity for a hearing, the Commissioner
				may impose a monetary penalty on any person or group found to be in violation
				of any of the provisions of
				211 CMR 67.00, M.G.L. c. 152,
				or any other applicable law or regulation. The monetary penalty shall not
				exceed $1,000 for each act or violation, not to exceed an aggregate monetary
				penalty of $10,000. The amount of any such monetary penalty shall be paid to
				the Commissioner for the use of the Division. Such penalty shall be in addition
				to any other penalty provided by law.
Code of Massachusetts Regulations › 211 CMR - DIVISION OF INSURANCE › Title 211 CMR 67.00 - Workers' Compensation Self-insurance Groups › Section 67.24 - Severability

Current through Register 1525, July 5, 2024
If any section or portion of a section of
				211 CMR 67.00 or the
				applicability thereof to any person, entity or circumstance is held invalid by
				a court, the remainder of
				211 CMR 67.00 or the
				applicability of such provision to other persons, entities or circumstances,
				shall not be affected thereby.
Code of Massachusetts Regulations › 211 CMR - DIVISION OF INSURANCE › Title 211 CMR 71.00 - Medicare Supplement Insurance To Facilitate The Implementation Of M.G.L. c. 176k And Section 1882 Of The Federal Social Security Act › Section 71.01 - Purpose

Current through Register 1525, July 5, 2024
The purpose of
				211 CMR 71.00 is to provide
				for the implementation of M.G.L. c. 176K and the federal Social Security Act
				§ 1882; to provide for the reasonable standardization and simplification
				of the terms, benefits, organization and format of Medicare Supplement
				Insurance Policies; to facilitate public understanding and comparison of such
				Policies; to ensure that Policies are written in an easily understood manner;
				to provide for the full disclosure of Policy contents; to eliminate provisions
				contained in such Policies which may be misleading or confusing in connection
				with the purchase of such Policies or with the settlement of claims; to prevent
				the sale of coverage which does not in fact complement Medicare; to ensure fair
				marketing; to prevent deceptive sales practices; to provide for full disclosure
				in the sale of accident and sickness insurance coverage to persons eligible for
				Medicare; and to facilitate review of rates for Medicare Supplement
				Insurance.
Code of Massachusetts Regulations › 211 CMR - DIVISION OF INSURANCE › Title 211 CMR 71.00 - Medicare Supplement Insurance To Facilitate The Implementation Of M.G.L. c. 176k And Section 1882 Of The Federal Social Security Act › Section 71.02 - Applicability, Scope and Effective Date

Current through Register 1525, July 5, 2024
(1)
			 Except as otherwise provided in
			 211 CMR 71.00,
			 211 CMR 71.00 shall apply to:
(a) All Medicare Supplement Insurance
			 Policies offered, sold, issued, delivered, or otherwise made effective or
			 renewed in Massachusetts on or after April 19, 1996;
(b) All Certificates issued under group
			 Medicare Supplement Insurance Policies which Certificates have been offered,
			 sold, issued, delivered or otherwise made effective or renewed in Massachusetts
			 on or after April 19, 1996; and
(c)
			 provided however, that except as otherwise permitted or required under
			 211 CMR 71.03,
			 71.07(5),
			 71.12(3)
			  and
			 71.12(11),
			 all Medicare Supplement Insurance Policies and Certificates originally issued
			 to be effective prior to January 1, 1995 shall be Guaranteed Renewable and
			 Issuers shall continue to renew all Medicare Supplement Insurance Policies and
			 Certificates originally issued to be effective prior to July 30, 1992, if
			 required under the terms and conditions of those Policies and Certificates; and
			 provided, further, that Health Maintenance Organizations shall continue to
			 renew Evidences of Coverage Issued Pursuant to a Medicare Part C Contract with
			 Medicare originally made effective prior to January 1, 1995, if required under
			 the terms and conditions of those Evidences of Coverage.
Code of Massachusetts Regulations › 211 CMR - DIVISION OF INSURANCE › Title 211 CMR 71.00 - Medicare Supplement Insurance To Facilitate The Implementation Of M.G.L. c. 176k And Section 1882 Of The Federal Social Security Act › Section 71.04 - Readability Standards

Current through Register 1525, July 5, 2024
(1) The text of all
			 Policy forms not exempted under M.G.L. c. 175, § 2B must meet the
			 requirements of M.G.L. c. 175, § 2B, including a minimum Flesch
			 readability score of 50. All forms shall be written in clear and understandable
			 English. When possible, technical terms must be avoided. If a technical term
			 cannot be avoided, it must be defined at least one time.
(2) The text of all riders and endorsements
			 to be used with such Policy forms shall separately achieve a Flesch score of 50
			 or higher. If such a form fails to meet this standard, an explanation must be
			 given of why this standard cannot be met and the certification made pursuant to
			 211
			 CMR 71.12(8)(n)  must
			 indicate that such form, in conjunction with any other form or combinations of
			 forms to which it will be attached, will achieve a score of 50 or
			 higher.
Code of Massachusetts Regulations › 211 CMR - DIVISION OF INSURANCE › Title 211 CMR 71.00 - Medicare Supplement Insurance To Facilitate The Implementation Of M.G.L. c. 176k And Section 1882 Of The Federal Social Security Act › Section 71.06 - Policy Limitations

Current through Register 1525, July 5, 2024
(1) No Medicare
			 Supplement Insurance Policy shall be advertised, solicited, issued, renewed,
			 delivered or issued for delivery which contains any waiting period or
			 preexisting condition limitation or exclusion.
(2) No Medicare Supplement Insurance Policy
			 shall contain limitations or exclusions on coverage that are more restrictive
			 than those of Medicare.
(3)
			 Limitations on benefits shall be so labeled in a separate section of the
			 Medicare Supplement Insurance Policy as well as placed with the benefit
			 provisions to which they apply.
(4)
			 No Medicare Supplement Insurance Policy shall contain benefits that duplicate
			 benefits provided by Medicare. No Medicare Supplement Insurance Policy offered
			 or sold after December 31, 2005 shall provide payment for drugs or biologicals
			 eligible for coverage under Medicare Part D.
(5) A Medicare Supplement Insurance Policy
			 with benefits for outpatient prescription drugs shall not be offered or sold
			 after December 31, 2005. A Medicare Supplement 1 policy shall, on or after
			 January 1, 2020, only be offered to Eligible Persons who:
(a) have attained 65 years of age before
			 January 1, 2020; or
(b) first
			 become eligible for Medicare due to age, disability or end-stage renal disease,
			 before January 1, 2020.
Code of Massachusetts Regulations › 211 CMR - DIVISION OF INSURANCE › Title 211 CMR 71.00 - Medicare Supplement Insurance To Facilitate The Implementation Of M.G.L. c. 176k And Section 1882 Of The Federal Social Security Act › Section 71.10 - Open Enrollment and Guarantee Issue for Medicare Supplement Insurance

Current through Register 1525, July 5, 2024
(1) No Issuer
			 participating in the market for Medicare Supplement Insurance shall at any time
			 deny or condition the issuance of any Medicare Supplement Insurance Policy or
			 Alternate Innovative Benefit Rider for sale in Massachusetts, nor discriminate
			 in the pricing of such a plan, to any Eligible Person because of the age,
			 health status, claims experience, receipt of health care, medical condition, or
			 genetic information of the Eligible Person. No Issuer participating in the
			 market for Medicare Supplement Insurance shall require genetic tests or private
			 genetic information as a condition of the issuance or renewal of a Medicare
			 Supplement Insurance Policy or Alternate Innovative Benefit Rider.
(2) No Medicare Supplement Insurance Policy
			 or Alternate Innovative Benefit Rider may contain any waiting period or
			 preexisting condition limitation or exclusion.
(3)
Required Part B Open
			 Enrollment Period
. An Issuer of Medicare Supplement Insurance
			 shall not deny or condition the issuance or effectiveness of any Medicare
			 Supplement Insurance Policy available for sale in Massachusetts, nor any
			 Alternate Innovative Benefit Rider, nor discriminate in the pricing of such a
			 Policy because of the health status, claims experience, receipt of health care,
			 or medical condition of an Applicant in the case of an application for a Policy
			 for which the Applicant is eligible that is submitted prior to or during the
			 six-month period beginning with the first day of the first month in which an
			 individual is both 65 years of age or older and is enrolled for benefits under
			 Medicare Part B. Each Medicare Supplement Insurance Policy or Alternate
			 Innovative Benefit Rider currently available from an Issuer shall be made
			 available to all Eligible Persons who apply and who qualify under 211 CMR
			 71.10(3), except as provided in 211 CMR 71.10(11). Notwithstanding 211 CMR
			 71.10(3), a Medicare Supplement 1 Insurance Policy may only be offered to
			 Medicare Eligible persons if the individual has also:
(a) attained 65 years of age before January
			 1, 2020; or
(b) first become
			 eligible for Medicare due to age, disability, or end-stage renal disease before
			 January 1, 2020.
Code of Massachusetts Regulations › 211 CMR - DIVISION OF INSURANCE › Title 211 CMR 71.00 - Medicare Supplement Insurance To Facilitate The Implementation Of M.G.L. c. 176k And Section 1882 Of The Federal Social Security Act › Section 71.11 - Standards for Claims Payment

Current through Register 1525, July 5, 2024
(1) An Issuer of
			 Medicare Supplement Insurance shall comply with the Social Security Act §
			 1882(c)(3) (as enacted by section 4081(b)(2)(C) of the Omnibus Budget
			 Reconciliation Act of 1987 (OBRA) 1987, Pub. L. No. 100-203) by:
(a) Accepting a notice from a Medicare
			 carrier on dually assigned claims submitted by participating physicians and
			 suppliers as a claim for benefits in place of any other claim form otherwise
			 required and making a payment determination on the basis of the information
			 contained in that notice;
(b)
			 Notifying the participating physician or supplier and the beneficiary of the
			 payment determination;
(c) Paying
			 the participating physician or supplier directly;
(d) Furnishing, at the time of enrollment,
			 each enrollee with a card listing the Policy name, number and a central mailing
			 address to which notices from a Medicare carrier may be sent;
(e) Paying user fees for claim notices that
			 are transmitted electronically or otherwise; and
(f) Providing to the Secretary of Health and
			 Human Services, at least annually, a central mailing address to which all
			 claims may be sent by Medicare carriers.
Code of Massachusetts Regulations › 211 CMR - DIVISION OF INSURANCE › Title 211 CMR 71.00 - Medicare Supplement Insurance To Facilitate The Implementation Of M.G.L. c. 176k And Section 1882 Of The Federal Social Security Act › Section 71.12 - Policy Filings for Medicare Supplement Insurance and Rate Review

Current through Register 1525, July 5, 2024
(1)
(a) An
			 Issuer shall not offer, sell, deliver or issue for delivery, or otherwise make
			 effective, or renew a Medicare Supplement Insurance Policy defined in
			 211 CMR 71.08(2)
			  or an Alternate Innovative Benefit Rider
			 defined in
			 211 CMR 71.09(5)
			  to a resident of Massachusetts, unless the
			 Policy form has been filed with and approved by the Commissioner.
(b) An Issuer shall not offer, sell, deliver
			 or issue for delivery, or otherwise make effective, or renew a Medicare
			 Supplement Insurance Policy defined in
			 211 CMR 71.08(2)
			  or an Alternate Innovative Benefit Rider
			 defined in
			 211 CMR 71.09(5)
			  to a resident of Massachusetts, unless the
			 rates therefor have been filed with and approved by the Commissioner.
(c) An Issuer shall not use or change premium
			 rates for a Medicare Supplement Insurance Policy defined in
			 211 CMR 71.08(2)
			  or an Alternate Innovative Benefit Rider
			 defined in
			 211 CMR 71.09(5)
			  and issued in accordance with the provisions
			 of 211 CMR 71.12, unless the rates use a Community Rating method which has been
			 approved by the Commissioner.
(d)
			 An Issuer shall not use or change premium rates for a Medicare Supplement
			 Insurance Policy defined in
			 211 CMR 71.08(2)
			  or Alternate Innovative Benefit Rider
			 defined in
			 211 CMR
			 71.09(5), unless the rates,
			 rating schedule and supporting documentation have been filed with and approved
			 by the Commissioner in accordance with the filing requirements and procedures
			 prescribed in 211 CMR 71.12. An Issuer may file the rate for an Alternate
			 Innovative Benefit Rider separately from the associated Medicare Supplement
			 Insurance Policy or may file a single rate for the Alternate Innovative Benefit
			 Rider and the Medicare Supplement Insurance Policy with which it is
			 associated.
Code of Massachusetts Regulations › 211 CMR - DIVISION OF INSURANCE › Title 211 CMR 71.00 - Medicare Supplement Insurance To Facilitate The Implementation Of M.G.L. c. 176k And Section 1882 Of The Federal Social Security Act › Section 71.15 - Appropriateness of Recommended Purchase and Excessive Insurance

Current through Register 1525, July 5, 2024
(1) In recommending the purchase or
			 replacement of any Medicare Supplement Insurance Policy a producer and/or
			 Issuer shall make reasonable efforts to determine the appropriateness of a
			 recommended purchase or replacement.
(2) Any sale of Medicare Supplement coverage
			 that will provide an individual more than one Medicare Supplement Insurance
			 Policy is prohibited.
(3) An Issuer
			 shall not issue a Medicare Supplement Insurance Policy to an individual
			 enrolled in Medicare Part C, unless the effective date of coverage is after the
			 termination date of the individual's Part C coverage.
Code of Massachusetts Regulations › 211 CMR - DIVISION OF INSURANCE › Title 211 CMR 71.00 - Medicare Supplement Insurance To Facilitate The Implementation Of M.G.L. c. 176k And Section 1882 Of The Federal Social Security Act › Section 71.16 - Standards for Marketing

Current through Register 1525, July 5, 2024
(1) Every Issuer or
			 other entity marketing Medicare Supplement Insurance in Massachusetts directly
			 or through its producers, shall establish marketing procedures:
(a) to ensure that any comparison of Policies
			 by its agents or other producers will be fair and accurate.
(b) to ensure excessive insurance is not sold
			 or issued.
(c) to ensure that
			 Insureds are informed that the Policy they are purchasing does not cover all of
			 the costs associated with medical care incurred by the Insureds by displaying
			 the following prominently by type, stamp or other appropriate means on the
			 first page of the Policy:
"Notice to Buyer: This Policy may not cover all of your medical
				expenses."
(d) to inquire
			 and otherwise make every reasonable effort to identify whether a prospective
			 Applicant or enrollee for Medicare Supplement Insurance already has accident
			 and sickness insurance and the types and amounts of any such
			 insurance.
(e) to ensure that
			 Applicants and Insureds are clearly informed of the basic nature and provisions
			 of their Medicare Supplement Insurance Policy.
(f) to ensure that Insureds are clearly
			 informed as to the benefits provided by Medicare.
Code of Massachusetts Regulations › 211 CMR - DIVISION OF INSURANCE › Title 211 CMR 71.00 - Medicare Supplement Insurance To Facilitate The Implementation Of M.G.L. c. 176k And Section 1882 Of The Federal Social Security Act › Section 71.17 - Filing Requirements for Advertising

Current through Register 1525, July 5, 2024
As soon as possible, but no later than 15 days before an
				Advertisement is used, every Issuer providing Medicare Supplement Insurance in
				Massachusetts shall file with the Commissioner for review, any Advertisement,
				whether through written, radio or television medium, intended for use in
				Massachusetts. Such Advertisements shall comply with all applicable
				laws.
Code of Massachusetts Regulations › 211 CMR - DIVISION OF INSURANCE › Title 211 CMR 71.00 - Medicare Supplement Insurance To Facilitate The Implementation Of M.G.L. c. 176k And Section 1882 Of The Federal Social Security Act › Section 71.18 - Permitted Producer Compensation Arrangements

Current through Register 1525, July 5, 2024
(1) An Issuer or other entity may provide
			 commissions or other compensation to a producer for the sale of a Medicare
			 Supplement Insurance Policy only if the first year commission or other first
			 year compensation is no more than 200% of the commission or other compensation
			 paid for selling or servicing the Policy in the second year or
			 period.
(2) The commission or other
			 compensation provided in subsequent (renewal) years must be the same as that
			 provided in the second year or period and must be provided for no fewer than
			 five renewal years.
(3) No entity
			 shall provide compensation to its producers and no producer shall receive
			 compensation greater than the renewal compensation payable by the replacing
			 Issuer on renewal Policies if an existing Policy is replaced.
Code of Massachusetts Regulations › 211 CMR - DIVISION OF INSURANCE › Title 211 CMR 71.00 - Medicare Supplement Insurance To Facilitate The Implementation Of M.G.L. c. 176k And Section 1882 Of The Federal Social Security Act › Section 71.19 - Reporting of Multiple Policies

Current through Register 1525, July 5, 2024
(1) On or
			 before March 1st of each year, an Issuer shall
			 report the following information for every individual resident of Massachusetts
			 for which the Issuer has in force more than one Medicare Supplement Insurance
			 Policy:
(a) Policy and Certificate number;
			 and
(b) date of issuance.
Code of Massachusetts Regulations › 211 CMR - DIVISION OF INSURANCE › Title 211 CMR 71.00 - Medicare Supplement Insurance To Facilitate The Implementation Of M.G.L. c. 176k And Section 1882 Of The Federal Social Security Act › Section 71.20 - Permitted Surcharges or Discounts for Medicare Supplement Insurance

Current through Register 1525, July 5, 2024
(1) To the extent permitted by federal law
			 and subject to the provisions of
			 211
			 CMR 71.10(5), an Issuer may
			 apply a surcharge to the premium for a Medicare Supplement Insurance Policy for
			 an Eligible Person who is a Late Enrollee or who Upgrades Coverage. For Late
			 Enrollees, a surcharge may be applied, unless the Reasonably Actuarially
			 Equivalent prior coverage was continuous from either the Late Enrollee's
			 initial eligibility or three years prior to the effective date of the new
			 coverage, whichever is later. Any surcharge may not exceed 15% annually and may
			 not be charged for more than three years from the date it is imposed by the
			 carrier. Each annual surcharge shall be applied to the premium for that year.
			 No surcharge may be imposed by an Issuer, unless that Issuer also applies
			 discounts for the Medicare Supplement Insurance Policy in accordance with 211
			 CMR 71.20(2).
(2) To the extent
			 permitted by federal law, as of January 1, 1995, an Issuer may discount the
			 premium for such Medicare Supplement Insurance Policy for a person who has
			 enrolled during the six-month period beginning at the time the person become
			 initially eligible for coverage after 65 years of age. Any discount may not
			 exceed 15% annually and may not be applied for more than three years from the
			 date the Eligible Person first receives coverage. Each annual discount shall be
			 applied against the premium for that year.
(3) To the extent permitted by federal law,
			 an Issuer desires to apply a surcharge or discount to the premium for a
			 Medicare Supplement Insurance Policy shall support its proposed surcharge or
			 discount in its Rate Filing as provided in
			 211
			 CMR 71.12(10)(f).
(4) To the extent permitted by federal law,
			 an Issuer that applies a surcharge or discount to the premium for a Medicare
			 Supplement Insurance Policy shall comply with the refund and credit calculation
			 requirements of
			 211
			 CMR 71.12(12).
Code of Massachusetts Regulations › 211 CMR - DIVISION OF INSURANCE › Title 211 CMR 71.00 - Medicare Supplement Insurance To Facilitate The Implementation Of M.G.L. c. 176k And Section 1882 Of The Federal Social Security Act › Section 71.21 - Medicare Select

Current through Register 1525, July 5, 2024
(1) 211 CMR 71.21
			 shall apply to Medicare Select Policies, as defined in 211 CMR 71.21.
(2) No policy may be advertised as a Medicare
			 Select Policy, unless it meets the requirements of 211 CMR 71.21.
(3) No Issuer may offer a Medicare Select
			 Policy, unless that Issuer also offers a Medicare Supplement Core plan that is
			 not a network plan.
(4) For the
			 purposes of 211 CMR 71.21:
(a)
Complaint
means any dissatisfaction expressed by an
			 Individual concerning a Medicare Select Issuer or its Network
			 Providers.
(b)
Grievance
means dissatisfaction expressed in writing
			 by an Individual Insured under a Medicare Select Policy with the
			 administration, claims practices, or provision of services concerning a
			 Medicare Select Issuer or its Network Providers.
(c)
Medicare Select
			 Issuer
means an Issuer offering, or seeking to offer, a Medicare
			 Select Policy.
(d)
Medicare Select Policy
means a Medicare Supplement
			 Insurance Policy that contains Restricted Network Provisions.
(e)
Network Provider
means a provider of health care or a group of providers of health care, which
			 has entered into a written agreement with the Issuer to provide benefits
			 insured under a Medicare Select Policy.
(f)
Restricted Network
			 Provision
means any provision which conditions the payment or
			 benefits, in whole or in part, on the use of Network Providers.
(g)
Service Area
means the geographic area approved by the Commissioner within which an Issuer
			 is authorized to offer a Medicare Select Policy.
Code of Massachusetts Regulations › 211 CMR - DIVISION OF INSURANCE › Title 211 CMR 71.00 - Medicare Supplement Insurance To Facilitate The Implementation Of M.G.L. c. 176k And Section 1882 Of The Federal Social Security Act › Section 71.22 - Withdrawal from the Market for Medicare Supplement Insurance

Current through Register 1525, July 5, 2024
(1) An Issuer that participates in the market
			 for Medicare Supplement Insurance on or after January 1, 1995 may not withdraw
			 from the market until all the Insureds of the Issuer have had an opportunity to
			 obtain coverage as of the next June 1st under a
			 Medicare Supplement Insurance Policy offered by another Issuer during the
			 annual open enrollment period outlined in
			 211
			 CMR 71.10(5), or the open
			 enrollment periods outlined in
			 211
			 CMR 71.10(3) and (4) if such
			 open enrollment periods allow all of the Issuer's Insureds to obtain coverage
			 prior to the next June 1st.
(2) An Issuer that withdraws from the market
			 for Medicare Supplement Insurance pursuant to 211 CMR 71.22(1), shall provide
			 to the Commissioner of Insurance a notice of withdrawal and withdrawal plan at
			 least 60 days prior to February 1st of any calendar
			 year which is the start of the annual open enrollment period pursuant to
			 211
			 CMR 71.10(5). Such
			 withdrawal plan shall describe in detail how the Issuer intends to comply with
			 211 CMR 71.22(1) and shall be subject to the Commissioner's approval. In
			 addition, the Issuer shall be required to provide written notice to all of its
			 Insureds of the approved withdrawal plan.
(3) An Issuer that withdraws from the market
			 for Medicare Supplement Insurance on or after January 1, 1995 may not
			 Participate in the Market for Medicare Supplement Insurance in Massachusetts
			 for five years from the date of withdrawal, unless the Commissioner finds that
			 such reentry shall be permitted earlier than five years due to a compelling
			 interest.
(4) For the purposes of
			 211 CMR 71.22(1) through (3), "Withdraw or Withdraws from the Market" shall
			 mean that the Issuer has discontinued the availability of all of its Policy
			 forms pursuant to
			 211
			 CMR 71.12(6).
(5) For the purposes of 211 CMR 71.22(2) and
			 (3), the "Date of Withdrawal" shall mean the date which the Issuer discontinued
			 the availability of all of its Policy forms pursuant to 211 CMR
			 71.22(1).
Code of Massachusetts Regulations › 211 CMR - DIVISION OF INSURANCE › Title 211 CMR 71.00 - Medicare Supplement Insurance To Facilitate The Implementation Of M.G.L. c. 176k And Section 1882 Of The Federal Social Security Act › Section 71.23 - Annual Public Hearing to Monitor Market Condition

Current through Register 1525, July 5, 2024
(1) The Commissioner shall annually conduct a
			 public hearing to monitor the overall condition of the Massachusetts market so
			 as to improve access by individuals to coverage under
			 211 CMR 71.00, to encourage
			 aggregation of risk pools through product selection and to promote long-term
			 access by individuals to coverage through continued stability and financial
			 viability of all carriers in the market. Such hearing shall be conducted during
			 the month of June each year, unless otherwise determined by the Commissioner.
			 Interested parties are encouraged to suggest issues to be addressed at the
			 hearing by filing a request with the Commissioner no later than April
			 15th of each year.
(2) The Commissioner shall also file with the
			 committee on insurance any recommendations for legislation to improve the
			 accessibility and affordability of coverage in the market.
Code of Massachusetts Regulations › 211 CMR - DIVISION OF INSURANCE › Title 211 CMR 71.00 - Medicare Supplement Insurance To Facilitate The Implementation Of M.G.L. c. 176k And Section 1882 Of The Federal Social Security Act › Section 71.24 - Severability

Current through Register 1525, July 5, 2024
If any section or portion of a section of
				211 CMR 71.00, or the
				applicability thereof to any person or circumstance is held invalid by any
				court of competent jurisdiction, the remainder of
				211 CMR 71.00, 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 74.00 - Standards Of Fault To Be Used By The Board Of Appeal On Motor Vehicle Liability Policies And Bonds And Insurers In Presuming Fault When Making At Fault Determinations › Section 74.01 - Authority

Current through Register 1525, July 5, 2024
211 CMR 74.00 is promulgated
				according to the authority granted the Board of Appeal on Motor Vehicle
				Liability Policies and Bonds by M.G.L. c. 26, § 8A, and M.G.L. c. 175,
				§ 113P; and the authority granted the Commissioner of Insurance by M.G.L.
				c. 175E, §§ 7A and 10.
Code of Massachusetts Regulations › 211 CMR - DIVISION OF INSURANCE › Title 211 CMR 74.00 - Standards Of Fault To Be Used By The Board Of Appeal On Motor Vehicle Liability Policies And Bonds And Insurers In Presuming Fault When Making At Fault Determinations › Section 74.02 - Purpose and Scope

Current through Register 1525, July 5, 2024
The Standards of Fault contained in
				211
				CMR 74.04 shall be applied by Insurers and
				the Board of Appeal on Motor Vehicle Liability Policies and Bonds when
				determining whether to presume an Operator of a Private Passenger Motor Vehicle
				is more than 50% at fault for an Accident.
Code of Massachusetts Regulations › 211 CMR - DIVISION OF INSURANCE › Title 211 CMR 74.00 - Standards Of Fault To Be Used By The Board Of Appeal On Motor Vehicle Liability Policies And Bonds And Insurers In Presuming Fault When Making At Fault Determinations › Section 74.03 - Definitions

Current through Register 1525, July 5, 2024
Accident
. An unexpected, unintended
				event arising out of the ownership, maintenance or use of a Private Passenger
				Motor Vehicle that results in a claim to an Insurer under a Private Passenger
				Motor Vehicle insurance policy.
At Fault Accident
. An Accident
				involving a Private Passenger Motor Vehicle in which its Operator was more than
				50% at fault.
Board
. The Board of Appeal on Motor
				Vehicle Liability Policies and Bonds established pursuant to M.G.L. c. 26,
				§ 8A.
Center Line
. Pavement marking,
				imaginary, drawn, or otherwise designated, which separates traffic moving in
				opposite directions.
Collision, Collides
. The accidental
				upset of a vehicle or any physical contact of a vehicle with an object or a
				person.
Commissioner
. The Commissioner of
				Insurance appointed pursuant to M.G.L. c. 26, § 6.
Insurer
. Any corporation, association,
				partnership, group or individual authorized to write Private Passenger Motor
				Vehicle insurance in the Commonwealth.
Operator
. Any person who is operating
				a Private Passenger Motor Vehicle, whether or not the Operator owns the
				vehicle.
Private Passenger Motor Vehicle
. Any
				vehicle, except a motorized vehicle not normally driven on public ways, that is
				insured by a Private Passenger Motor Vehicle insurance policy.
Standards of Fault
. The standards
				referred to in M.G.L. c. 175E, § 7A, and M.G.L. c. 175, § 113P, which
				are contained in
				211
				CMR 74.04.
Code of Massachusetts Regulations › 211 CMR - DIVISION OF INSURANCE › Title 211 CMR 74.00 - Standards Of Fault To Be Used By The Board Of Appeal On Motor Vehicle Liability Policies And Bonds And Insurers In Presuming Fault When Making At Fault Determinations › Section 74.04 - Standards of Fault: Circumstances in Which an Operator's Fault Is Presumed to Be More than 50%

Current through Register 1525, July 5, 2024
The following Standards of Fault shall be considered
				determinative that an Operator of a Private Passenger Motor Vehicle was more
				than 50% at fault for an Accident, unless a showing to the contrary is
				demonstrated by the evidence presented in the course of review of the At Fault
				Accident.
(01)
Collision
			 with a Person or a Lawfully or Unlawfully Parked Vehicle
. The
			 Operator collides with a person or a lawfully or unlawfully parked
			 vehicle.
(03)
Rear End
			 Collision
. The Operator collides with the rear section of another
			 vehicle.
(05)
Out of
			 Lane Collision
. The Operator, when operating a vehicle which is
			 partially or completely out of its proper lane, thereafter collides with
			 another vehicle:
(a) while being passed by
			 the other vehicle, the passing vehicle being in its proper lane; or
(b) while passing the other vehicle, the
			 other vehicle being in its proper lane; or
(c) while changing or turning into or across
			 the other vehicle's lane.
Code of Massachusetts Regulations › 211 CMR - DIVISION OF INSURANCE › Title 211 CMR 74.00 - Standards Of Fault To Be Used By The Board Of Appeal On Motor Vehicle Liability Policies And Bonds And Insurers In Presuming Fault When Making At Fault Determinations › Section 74.05 - Violations

Current through Register 1525, July 5, 2024
An Insurer's failure to apply the standards established by
				211 CMR 74.00 in presuming or
				determining an Operator to be more than 50% at fault for an Accident may be a
				violation of M.G.L. c. 176D, § 2.
Code of Massachusetts Regulations › 211 CMR - DIVISION OF INSURANCE › Title 211 CMR 74.00 - Standards Of Fault To Be Used By The Board Of Appeal On Motor Vehicle Liability Policies And Bonds And Insurers In Presuming Fault When Making At Fault Determinations › Section 74.06 - Severability

Current through Register 1525, July 5, 2024
If any section or portion of a section of
				211 CMR 74.00 or the
				applicability thereof to any person, entity, or circumstance is held to be
				invalid by a court of competent jurisdiction, the remainder of
				211 CMR 74.00 or the
				applicability of such provision to other persons, entities or circumstances,
				shall not be affected thereby.
Code of Massachusetts Regulations › 211 CMR - DIVISION OF INSURANCE › Title 211 CMR 75.00 - Reporting The Theft Of A Motor Vehicle › Section 75.01 - Authority

Current through Register 1525, July 5, 2024
211 CMR 75.00 is promulgated
				in accordance with the authority granted to the Commissioner of Insurance by
				M.G.L. c. 175, § 113O.
Code of Massachusetts Regulations › 211 CMR - DIVISION OF INSURANCE › Title 211 CMR 75.00 - Reporting The Theft Of A Motor Vehicle › Section 75.02 - Definitions

Current through Register 1525, July 5, 2024
As used in
				211 CMR 75.00 the following
				words shall mean:
Commissioner
. The Commissioner of
				Insurance appointed pursuant to M.G.L. c. 26, § 6.
Designated Organization
. The
				Commissioner designates the National Insurance Bureau or its successor
				organization (hereinafter NICB) as the central organization engaged in motor
				vehicle loss prevention as required by M.G.L. c. 175, § 113O.
Insurer
. Any corporation, association,
				partnership, group or individual authorized to write motor vehicle insurance in
				the Commonwealth.
Major Component Part
. The engine,
				transmission, front end assembly, hood, doors, trunk lid, and rear clip of a
				motor vehicle on which a unique vehicle identifying number has been
				placed.
Code of Massachusetts Regulations › 211 CMR - DIVISION OF INSURANCE › Title 211 CMR 75.00 - Reporting The Theft Of A Motor Vehicle › Section 75.03 - Purpose and Scope

Current through Register 1525, July 5, 2024
211 CMR 75.00 shall govern
				the reporting of motor vehicle thefts or misappropriations between insurers and
				the National Insurance Crime Bureau in accordance with M.G.L. c. 175, §
				113O. Its purpose is to prevent payment of fraudulent claims arising under
				motor vehicle insurance policies and to conduct activities to prevent motor
				vehicle theft conditions. Such activities shall include, but not be limited to,
				cooperation with duly constituted law enforcement agencies involved in the
				prevention and control of motor vehicle theft conditions and providing
				assistance to duly authorized officials and law enforcement officers in the
				investigation and control of said conditions.
Code of Massachusetts Regulations › 211 CMR - DIVISION OF INSURANCE › Title 211 CMR 75.00 - Reporting The Theft Of A Motor Vehicle › Section 75.04 - National Insurance Crime Bureau's Responsibilities

Current through Register 1525, July 5, 2024
(1)
Central Index
			 File
. The NICB shall establish and keep a central index file in a
			 manner approved by the Commissioner for all motor vehicle thefts or
			 misappropriations reported by insurers.
(2)
Report
			 Acknowledgment
. The NICB shall acknowledge the receipt of each
			 theft report received from an insurer within ten working days.
(3)
Cooperation with
			 Insurers
. The NICB shall cooperate with insurers in the resolution
			 of errors and the investigation of claims suspected to be fraudulent.
Code of Massachusetts Regulations › 211 CMR - DIVISION OF INSURANCE › Title 211 CMR 75.00 - Reporting The Theft Of A Motor Vehicle › Section 75.05 - Insurer's Responsibilities

Current through Register 1525, July 5, 2024
(1)
Reporting Requirements
. Insurers shall report all
			 thefts and misappropriations of a motor vehicle or of its major component parts
			 to the NICB within two working days from the receipt of sufficient information
			 from the insured. If the insurer has not received any acknowledgment or
			 communication from the NICB within ten working days following its submission of
			 the total theft report to the NICB, the insurer shall immediately communicate
			 with the NICB to determine the status of its report.
All total losses, however sustained, involving salvage, shall
				be reported to the NICB within five working days after the sale of salvage, or
				if the insured is permitted to retain salvage, within five working days after
				the date of loss payment.
(2)
Deferred Claim Processing and
			 Payment
. Notwithstanding the provisions of 211 CMR 89.00, an
			 insurer shall defer the processing and payment of a claim filed under
			 comprehensive coverage in accordance with 211 CMR 75.05(2)(a) through (d):
(a) No insurer shall pay a claim filed by an
			 insured under comprehensive coverage for the theft or misappropriation of a
			 motor vehicle or its major component parts unless said claim has been reported
			 to and acknowledged by the NICB.
(b) If the NICB indicates in its response to
			 the insurer that coverage is in effect by more than one insurer for the same
			 vehicle or that the vehicle has been previously reported as stolen and
			 unrecovered or that previous similar claims on the same vehicle have been
			 reported, the insurer shall promptly investigate and resolve such
			 discrepancy.
(c) If the NICB
			 discovers an erroneous vehicle identification number (VIN) and the NICB is
			 unable to clear up such discrepancy internally, the NICB will send a
			 questionnaire to the insurer. This questionnaire shall be returned within five
			 working days of receipt by the insurer. If the NICB and insurer are
			 unsuccessful after due diligence in resolving the VIN error after a 30-day
			 period from date of report of loss to the insurer on a vehicle, the insurer may
			 proceed with the processing of the loss claim.
(d) If the NICB indicates in its response to
			 the insurer or the insurer finds that the loss may have been caused by the
			 criminal or fraudulent act of any person, the insurer shall suspend the
			 processing of the claim and promptly begin an investigation. The insurer shall
			 promptly provide such information to the NICB and shall cooperate fully with
			 the NICB in its investigation of criminal or fraudulent acts.
Code of Massachusetts Regulations › 211 CMR - DIVISION OF INSURANCE › Title 211 CMR 75.00 - Reporting The Theft Of A Motor Vehicle › Section 75.06 - Costs of Administration

Current through Register 1525, July 5, 2024
The NICB is hereby authorized to make assessments, in such
				manner as its Governing Board may determine, among all licensed insurers in the
				Commonwealth, to reimburse NICB for the costs of the performance of its duties
				under M.G.L. c. 175, § 113O. Such assessments shall be prorated upon the
				basis on net fire and theft premiums written under comprehensive policies, or
				insurance pertaining to the ownership, use or maintenance of motor vehicles
				written by each insurer in the Commonwealth. Each such insurer which is a
				member of the NICB shall be entitled to a credit against the assessments
				authorized hereunder for all assessments directly related to Massachusetts
				premiums paid by it to the NICB on account of its membership during the period
				covered by said assessment.
Code of Massachusetts Regulations › 211 CMR - DIVISION OF INSURANCE › Title 211 CMR 75.00 - Reporting The Theft Of A Motor Vehicle › Section 75.07 - Immunity

Current through Register 1525, July 5, 2024
No insurer or the NICB or their employees or agents, and no
				commissioner or employees or agents of the commissioner and no official or
				officer of any law enforcement agency, shall be subject to civil or criminal
				liability in acause of actio no fany kind for furnishing any evidence or
				information to the commissioner, his employees or any law enforcement agency or
				any other insurer relating to an investigation conducted involving losses for
				motor vehicles due to suspected incendiary origin, notwithstanding the
				provisions of M.G.L. c. 148, § 32.
Code of Massachusetts Regulations › 211 CMR - DIVISION OF INSURANCE › Title 211 CMR 75.00 - Reporting The Theft Of A Motor Vehicle › Section 75.08 - Duty to Report

Current through Register 1525, July 5, 2024
(1) Whenever the
			 NICB or the insurer has reasonable cause to believe that the loss may have been
			 caused by anycriminalor fraudulent act of any person, it shall notify the
			 appropriate law enforcement agency or the NICB of that belief.
(2) All insurers required to submit reports
			 to the N IC B for the p urp o se o f co mp lying with M. G.L. c. 175, §
			 113O and
			 211 CMR 75.00, shall be bound
			 by all of the reporting requirements of the NICB.
Code of Massachusetts Regulations › 211 CMR - DIVISION OF INSURANCE › Title 211 CMR 75.00 - Reporting The Theft Of A Motor Vehicle › Section 75.50 - Prescription of Forms for Motor Vehicle Theft Reports

Current through Register 1525, July 5, 2024
Pursuant to the authority granted him by M.G.L. c 175, §
				113O, as added by St. 1976, c. 266, the Commissioner of Insurance hereby
				prescribes the forms appended hereto for use in the reporting of all motor
				vehicle thefts.
Code of Massachusetts Regulations › 211 CMR - DIVISION OF INSURANCE › Title 211 CMR 75.00 - Reporting The Theft Of A Motor Vehicle › Section 75.51 - Description of the Requirements of Printing Forms

Current through Register 1525, July 5, 2024
This form shall be printed in triplicate. Additional copies, if
				needed, may be printed. The first copy shall go to the police authority to whom
				the report must be submitted. The second copy shall go to the insurer. The
				third copy shall be returned to the insured when he submits the form.
The paragraphs headed: TO INSURED FILING THIS REPORT shall
				either be printed at the top of the form or separately on the back of the last
				sheet of the form. The police copy shall be the only copy to contain
				211 CMR
				75.52 section 3 as that section concerns the
				recovery of the car and will therefor be filled out later.
The forms shall be printed on paper that is 8½" by 11".
Code of Massachusetts Regulations › 211 CMR - DIVISION OF INSURANCE › Title 211 CMR 77.00 - Procedures For The Conduct Of Proceedings On Fixed-and-established Private Passenger Motor Vehicle Insurance Rates › Section 77.01 - Purpose, Scope and Authority

Current through Register 1525, July 5, 2024
211 CMR 77.00, promulgated
				pursuant to M.G.L. c. 175, §§ 113B, 113C and 113L, governs
				proceedings on fixed-and-established motor vehicle insurance rates, including
				hearings and investigations to fix and establish fair and reasonable
				classifications of risks based on accident involvement and adequate, just,
				reasonable and non-discriminatory premium charges to be used and charged by
				companies in connection with the issue or execution of motor vehicle policies
				or bonds which are subject to regulation under M.G.L. c. 175, §§
				113B, 113C and 113L.
Code of Massachusetts Regulations › 211 CMR - DIVISION OF INSURANCE › Title 211 CMR 77.00 - Procedures For The Conduct Of Proceedings On Fixed-and-established Private Passenger Motor Vehicle Insurance Rates › Section 77.02 - Definitions

Current through Register 1525, July 5, 2024
As used in
				211 CMR 77.00, the following
				words mean:
Advisory filing
. Recommendations
				concerning rates, premium charges, and classifications of risks filed in
				accordance with
				211
				CMR 77.05(4).
Commissioner
. The Commissioner of
				Insurance appointed pursuant to M.G.L. c. 26, § 6, or his or her
				designee.
Division
. The Division of Insurance
				established pursuant to M.G.L. c. 26, § 1.
Filing
. Any document required to be
				submitted by
				211
				CMR 77.05(4)  and 211 CMR
				93.00, Cost and Expense Containment Standards for Motor Vehicle
				Insurers.
Insurer
. An insurance company
				authorized to write motor vehicle insurance in Massachusetts or a licensed
				rating organization authorized to act on its behalf.
Intervenor
. A person, agency, or
				organization which is granted permission, pursuant to
				211 CMR
				77.04(2)(d), to intervene in
				the whole or any portion of a proceeding.
Motor vehicle insurance
. Motor vehicle
				policies or bonds, both as defined in M.G.L. c. 90, § 34A and 34O and
				M.G.L. c. 175, §§ 113A, 113C and 113L.
Papers
. All written documents filed in
				a proceeding, including filings, motions, pleadings, briefs, memoranda, and
				other communications.
Participant
. A person, agency, or
				organization which is granted permission to make a limited appearance as set
				forth in
				211 CMR
				77.04(2)(d).
Party
. An insurer submitting an
				advisory filing, statutory intervenors, and intervenors. The Presiding Officer,
				in his or her discretion, may determine , based on the level of participation
				allowed, that a participant shall be treated as a party in a proceeding. For
				purposes of the procedures established by
				211 CMR 77.00, the State
				Rating Bureau shall be considered a party.
Petitioner
. A person, agency, or
				organization which files a petition pursuant to
				211 CMR 77.04(2)
				 for leave to intervene or
				participate.
Presiding Officer
. The Commissioner or
				a person designated by the Commissioner who conducts proceedings pursuant to
				211 CMR 77.00.
Proceeding
. A hearing and related
				procedural matters conducted under
				211 CMR 77.00.
Statistical data base
. Information
				gathered by an insurer as required by the Commissioner, including information
				submitted by the insurer in accordance with the statistical plan as authorized
				by the Commissioner under M.G.L. c. 175, § 113B.
State Rating Bureau
. The State Rating
				Bureau within the Division, established pursuant to M.G.L. c. 26, §
				8E.
Statutory intervenor
. A person,
				agency, or organization, including but not limited to the Attorney General,
				which has a statutory right to appear in a proceeding conducted pursuant to
				211 CMR
				77.00.
Code of Massachusetts Regulations › 211 CMR - DIVISION OF INSURANCE › Title 211 CMR 77.00 - Procedures For The Conduct Of Proceedings On Fixed-and-established Private Passenger Motor Vehicle Insurance Rates › Section 77.03 - General Provisions

Current through Register 1525, July 5, 2024
(1)
Filings
. All papers shall be filed at the Division's
			 principal office during regular business hours, addressed to the Docket Clerk,
			 Hearings and Appeals. Unless otherwise specified in
			 211 CMR 77.00, the Presiding
			 Officer shall determine how many copies of papers shall be filed. A party or
			 participant filing papers in a proceeding shall serve a copy there of on all
			 parties to the proceeding, by hand delivery or by United States mail, postage
			 prepaid, sent to the address of record in the proceeding. In addition, a party
			 or participant filing papers in a proceeding shall notify all participants that
			 papers have been filed. Failure to comply with 211 CMR 77.03(1) shall be
			 grounds for refusal by the Division to accept papers for filing.
(2)
Timely Filing
.
			 Papers filed in a proceeding must be filed at the Division's principal office
			 within the specified time limits. The date of filing shall be determined as
			 follows:
(a) Papers hand-delivered during
			 regular business hours shall be deemed filed on that day. Unless otherwise
			 ordered by the Presiding Officer, papers hand-delivered at other times shall be
			 deemed filed on the next regular business day.
(b) Papers mailed to the Division's principal
			 office shall be deemed filed on the day the Division receives them.