reglab/statecodes huggingface dataset:
Code of Massachusetts Regulations › 955 CMR - INSURANCE PREMIUM FINANCE AGENCY › Title 955 CMR 2.00 - The Financing Of Insurance Premiums › Section 2.09 - Account Books

Current through Register 1525, July 5, 2024
After the execution of a premium finance agreement and prior to the due date of the first payment to be made thereunder, a premium finance agency shall deliver to the insured a statement of account book or a coupon book. If the premium finance agreement contains any separate charge for credit insurance, a copy of the credit insurance policy or policies or a certificate or certificates of credit insurance, as appropriate, shall be attached to the statement of account book or coupon book.
Code of Massachusetts Regulations › 955 CMR - INSURANCE PREMIUM FINANCE AGENCY › Title 955 CMR 2.00 - The Financing Of Insurance Premiums › Section 2.10 - Effective Date

Current through Register 1525, July 5, 2024
This order shall be effective upon publication by the Office of the Secretary of State and shall apply to all agreements covering insurance contracts whose effective dates occur on or after July 2, 1984.
Code of Massachusetts Regulations › 956 CMR - COMMONWEALTH HEALTH INSURANCE CONNECTOR AUTHORITY › Title 956 CMR 5.00 - Minimum Creditable Coverage › Section 5.01 - General Provisions

Current through Register 1525, July 5, 2024
Scope and Purpose
.
				956 CMR
				5.00 establishes the criteria for the lowest threshold
				health benefit plan that an individual must purchase in order to satisfy the
				legal requirement that a Massachusetts Resident have health coverage that
				constitutes minimum creditable coverage so as to avoid paying a penalty to the
				Department of Revenue pursuant to M.G.L. c. 111M, § 2. Minimum creditable
				coverage is designed to provide individuals (and dependents) purchasing the
				coverage with financial access to a broad range of health care services,
				including preventive health care, without incurring severe financial losses as
				a result of serious illness or injury.
Code of Massachusetts Regulations › 956 CMR - COMMONWEALTH HEALTH INSURANCE CONNECTOR AUTHORITY › Title 956 CMR 5.00 - Minimum Creditable Coverage › Section 5.03 - Minimum Creditable Coverage

Current through Register 1525, July 5, 2024
(1) A Health Benefit
			 Plan, or the aggregate of multiple Health Benefit Plans, must satisfy the
			 requirements of
			 956
			 CMR 5.03(1)(a) through (f)
			 to be considered as providing minimum creditable coverage:
(a) A Health Benefit Plan provides Core
			 Services and a broad range of medical benefits, in accordance with at least the
			 minimum standards set by state and federal statutes and regulations governing
			 the particular Health Benefit Plan. "A broad range of medical benefits" shall
			 include, at a minimum, coverage for:
1.
			 Ambulatory Patient Services, including outpatient, day surgery and related
			 anesthesia;
2. Diagnostic imaging
			 and screening procedures, including x-rays;
3. Emergency services;
4. Hospitalization (including at a minimum,
			 inpatient acute care services which are generally provided by an acute care
			 hospital for covered benefits in accordance with the member's subscriber
			 certificate or plan description);
5. Maternity and newborn care, including
			 prenatal care, post-natal care, and delivery and inpatient services for
			 maternity care;
6. Medical/surgical
			 care, including Preventive Health Services and primary care;
7. Mental health and substance abuse
			 services;
8. Prescription
			 drugs;
9. Radiation therapy and
			 chemotherapy.
Code of Massachusetts Regulations › 956 CMR - COMMONWEALTH HEALTH INSURANCE CONNECTOR AUTHORITY › Title 956 CMR 5.00 - Minimum Creditable Coverage › Section 5.04 - Administrative Bulletins

Current through Register 1525, July 5, 2024
The Connector may periodically issue administrative bulletins
				containing interpretations of
				956
				CMR 5.00 and other information to assist compliance
				under
				956
				CMR 5.00.
Code of Massachusetts Regulations › 956 CMR - COMMONWEALTH HEALTH INSURANCE CONNECTOR AUTHORITY › Title 956 CMR 5.00 - Minimum Creditable Coverage › Section 5.05 - Severability

Current through Register 1525, July 5, 2024
The provisions of
				956
				CMR 5.00 are hereby declared to be severable. If any
				section or portion of sections
				956
				CMR 5.00, or the applicability thereof to any person
				or circumstances, is held invalid by any court of competent jurisdiction, the
				remainder of
				956
				CMR 5.00, or the applicability thereof to other
				persons or circumstances, will not be affected thereby.
Code of Massachusetts Regulations › 956 CMR - COMMONWEALTH HEALTH INSURANCE CONNECTOR AUTHORITY › Title 956 CMR 6.00 - Determining Affordability For The Individual Mandate › Section 6.01 - Authority

Current through Register 1525, July 5, 2024
956 CMR 6.00 is promulgated in
				accordance with the authority granted to the Connector by M.G.L. chs. 111M,
				118H, and 176Q.
Code of Massachusetts Regulations › 956 CMR - COMMONWEALTH HEALTH INSURANCE CONNECTOR AUTHORITY › Title 956 CMR 6.00 - Determining Affordability For The Individual Mandate › Section 6.02 - Purpose

Current through Register 1525, July 5, 2024
The purpose of
				956 CMR 6.00 is to implement
				the provisions of M.G.L. chs. 111M, 118H, and 176Q, pertaining to how state
				agencies, and Massachusetts residents will determine whether health insurance
				is affordable so that individuals who have not purchased health insurance may
				then determine whether they are obligated to pay a penalty pursuant to M.G.L.
				c. 111M, § 2. In general, if an individual is deemed able to afford to
				purchase insurance in accordance with
				956 CMR 6.00 and does not do
				so, that individual will be assessed the appropriate penalty by the
				Massachusetts Department of Revenue. Individuals who can demonstrate that no
				Connector health plans are affordable for them under the standards set pursuant
				to
				956 CMR 6.00 may seek a
				certificate that the penalty should not be assessed. At the same time, the
				Connector will implement, through
				956 CMR 6.00, an appeal
				process that will set standards allowingresidents to claim that a penalty
				should not be assessed because of financial hardship that prevented them from
				purchasing coverage.
				956 CMR 6.00 arises out of the
				health care reform enactments in St. 2006, ch. 58 which provide for an
				individual mandate designed to encourage Massachusetts residents to purchase
				health insurance.
Code of Massachusetts Regulations › 956 CMR - COMMONWEALTH HEALTH INSURANCE CONNECTOR AUTHORITY › Title 956 CMR 6.00 - Determining Affordability For The Individual Mandate › Section 6.03 - Scope

Current through Register 1525, July 5, 2024
956 CMR 6.00 contains the
				Connector's regulations governing how state agencies and individuals will
				determine whether, based on their income and other factors, Massachusetts
				residents are able to afford to purchase health insurance, as specified in
				M.G.L. chs. 111M, 118H, and 176Q. The Connector also promulgates other
				regulations, and publishes other documents affecting its programs, including
				statements of policy and procedure, conditions of participation, guidelines,
				billing instructions, administrative information bulletins and other documents
				as necessary
Code of Massachusetts Regulations › 956 CMR - COMMONWEALTH HEALTH INSURANCE CONNECTOR AUTHORITY › Title 956 CMR 6.00 - Determining Affordability For The Individual Mandate › Section 6.04 - Definitions

Current through Register 1525, July 5, 2024
As used in
				956 CMR 6.00, the following
				terms shall mean:
Adjusted Gross Income
- as defined in
				the Internal Revenue Code § 62.
Appellant
- an individual who
				brings:
(a) a hardship appeal under
				956 CMR 6.07;
				or
(b) an appeal of the denial of a certificate under
				956 CMR
				6.06.
Assessment
- the imposition of the
				penalty when either:
(a) a Massachusetts resident income tax return is filed, as
				provided in M.G.L. c. 62C, § 26(a); or
(b) the Commissioner of Revenue issues a deficiency assessment,
				as provided in M.G.L. c. 62C, § 26(b).
Board
- the Board of the Commonwealth
				Health Insurance Connector Authority, established by M.G.L. c. 176Q, §
				2.
Commonwealth Health Insurance Connector Authority
				or Connector or Authority
- the entity established pursuant to
				M.G.L. c. 176Q, § 2.
Couple
- two persons who are married
				and filed the Massachusetts resident income tax return as persons married
				filing jointly.
Dependent
- as defined in Internal
				Revenue Code § 152.
Family
- shall include any couple or
				head of household and their dependents.
Head of Household
- a person who meets
				the definition in Internal Revenue Code § 2(b) and who files the
				Massachusetts resident income tax return as a head of household.
Hardship Appeals
- any appeal brought
				under
				956 CMR 6.07
				through a from provided by the Department of Revenue in
				830
				CMR 111M.2.1
Hearing
- an administrative,
				adjudicatory proceeding pursuantto
				801 CMR 1.00 to determine the
				legal rights, duties, benefits or privileges of Appellants.
Individual
- a resident of the
				Commonwealth who files the Massachusetts resident income tax return as an
				individual or as a married person filing separately .
Minimum Creditable Coverage or Creditable
				Coverage
- As defined in
				956 CMR
				5.03.
Penalty
- the penalty imposed by
				M.G.L. c. 111M, § 2, for failure to obtain health insurance meeting
				standards fo rm inimum creditable coverage.
Potential Assessment
- the filing of a
				Massachusetts resident income tax return showing that a penalty is owed,
				accompanied by the filing of an appeal of that penalty under
				956 CMR
				6.07(2).
Premium or Premiums
- The periodic
				payment made by a resident for health insurance. The premium does not include
				any portion of the insurance cost paid by an employer or government
				agency.
Resident
- as defined under M.G.L. c.
				111M.
Section 125 Plan
- as defined in
				956 CMR
				4.05.
Code of Massachusetts Regulations › 956 CMR - COMMONWEALTH HEALTH INSURANCE CONNECTOR AUTHORITY › Title 956 CMR 6.00 - Determining Affordability For The Individual Mandate › Section 6.05 - Determining Affordability

Current through Register 1525, July 5, 2024
(1)
Affordability Schedule.
(a) The Board will formally vote to adopt an
			 affordability schedule annually, no later than June
			 1st of every year, that shall establish the
			 percentage of an individual's adjusted gross income that the individual can be
			 expected to contribute toward the cost of health insurance that meets minimum
			 creditable coverage standards. The Board shall also consider whether the
			 affordability schedule should establish percentages of adjusted gross income
			 that couples without dependents and/or families can be expected to contribute
			 toward the cost of health insurance that meets minimum creditable coverage
			 standards. The affordability schedule shall be issued for use by the
			 Massachusetts Department of Revenue, other state agencies, and members of the
			 public for their use in determining whether residents who have not purchased
			 health insurance can purchase affordable insurance and are thus subject to a
			 penalty for their failure to purchase insurance.
(b) The Board shall allow public comments
			 before it formally votes to adopt its annual affordability schedule.
(c) Before formally voting to adopt, the
			 Board will provide a copy of the schedule to the House and Senate Committee on
			 Ways and Means and the Joint Committee on Health Care Financing.
Code of Massachusetts Regulations › 956 CMR - COMMONWEALTH HEALTH INSURANCE CONNECTOR AUTHORITY › Title 956 CMR 6.00 - Determining Affordability For The Individual Mandate › Section 6.06 - Annual Certification

Current through Register 1525, July 5, 2024
(1)
			 The Connector will accept requests from residents who:
(a) will be filing a Massachusetts resident
			 income tax return;
(b) have sought
			 to purchase health insurance coverage through plans from the Connector;
			 and
(c) seek a certificate stating
			 that no Connector health plans are affordable to them.
Code of Massachusetts Regulations › 956 CMR - COMMONWEALTH HEALTH INSURANCE CONNECTOR AUTHORITY › Title 956 CMR 6.00 - Determining Affordability For The Individual Mandate › Section 6.07 - Hardship Appeals

Current through Register 1525, July 5, 2024
(1) Any person
			 aggrieved by the assessment or potential assessment of a penalty may bring a
			 hardship appeal in accordance with the provisions of 956 CMR 6.07. Filing a
			 hardship appeal in accordance with 956 CMR 6.07 will be the only means for a
			 taxpayer to appeal the penalty.
(2)
			 All hardship appeals must be filed by completing the form provided by the
			 Department of Revenue for that purpose. The Connector will not accept any other
			 form of appeal.
(3) A hardship
			 appeal form must be filed within the time limits established by M.G.L. c. 62C,
			 § 37 for the filing of an abatement.
(4) A person aggrieved by the potential
			 assessment of a penalty may file the hardship appeal form along with his
			 Massachusetts resident income tax return. In such a case, the penalty will not
			 be assessed unless and until the appeal has been decided adversely to the
			 taxpayer.
(5) After receipt of the
			 hardship appeal form, the Connector may request the Appellant to provide
			 further information about the grounds for the hardship appeal. Failure to
			 respond to this request within the time specified in the request will
			 constitute grounds for dismissal with prejudice of the hardship
			 appeal.
(6) The Connector may
			 authorize the Department of Revenue to accept on its behalf hardship appeals
			 and to request further information from Appellants. The Connector may further
			 authorize the Department of Revenue to conduct an initial review of the
			 information supplied by the taxpayer, and to allow the appeal if, based on
			 information supplied by the taxpayer, the Department determines in accordance
			 with standards set by the Connector that the taxpayer has established grounds
			 for the penalty to be waived. If, after initial review the Department does not
			 allow the appeal, it will refer the matter to the Connector for further review
			 pursuant to
			 956 CMR 6.09.
(7) For 2007, any hardship appeals granted
			 will be granted for the full calendar year.
(8) For 2008 and years thereafter, the
			 Connector may waive the penalty in whole or in part, depending on whether it
			 determines that the Appellant has established that grounds for the hardship
			 appeal existed for all or part of the calendar year for which the penalty was
			 assessed.
(9) A taxpayer will be
			 entitled to file only one hardship appeal to challenge the imposition of a tax
			 penalty for a particular tax year. After that appeal is heard and decided, the
			 Connector will dismiss any subsequent appeals concerning the same tax penalty
			 or tax year without a hearing.
Code of Massachusetts Regulations › 956 CMR - COMMONWEALTH HEALTH INSURANCE CONNECTOR AUTHORITY › Title 956 CMR 6.00 - Determining Affordability For The Individual Mandate › Section 6.08 - Grounds for Hardship Appeal

Current through Register 1525, July 5, 2024
(1) As
			 grounds for the hardship appeal, the Appellant must establish that, based on
			 all his circumstances, health insurance that provided minimum creditable
			 coverage was not affordable to him because he experienced a hardship. In
			 determining whether a hardship existed, the Connector shall consider whether,
			 within the tax year for which the penalty was assessed, the Appellant:
(a) was homeless, or was more than 30 days in
			 arrears in rent or mortgage payments, or received an eviction or foreclosure
			 notice;
(b) received a shut-off
			 notice, or was shut off, or was refused the delivery of essential utilities
			 (gas, electric, oil, water, or telephone);
(c) for the period ending December 31, 2008,
			 had non-cosmetic medical and/or dental out-of-pocket expenses (exclusive of
			 premium payments), totaling more than 7.5% of his household's adjusted gross
			 income that were not subject to payment by a third-party;
(d) incurred a significant, unexpected
			 increase in essential expenses resulting directly from the consequences of:
1. domestic violence;
2. the death of a spouse, family member, or
			 partner with primary responsibility for child care where that spouse, family
			 member or partner had shared household expenses;
3. the sudden responsibility for providing
			 full care for an aging parent or other family member, including a major,
			 extended illness of a child that requires a working parent to hire a full-time
			 caretaker for the child; or
4. a
			 fire, flood, natural disaster, or other unexpected natural or human-caused
			 event causing substantial household or personal damage for the individual
			 filing the appeal; or
(e) experienced financial circumstances such
			 that the expense of purchasing health insurance that met minimum creditable
			 coverage standards would have caused him to experience a serious deprivation of
			 food, shelter, clothing or other necessities.
Code of Massachusetts Regulations › 956 CMR - COMMONWEALTH HEALTH INSURANCE CONNECTOR AUTHORITY › Title 956 CMR 6.00 - Determining Affordability For The Individual Mandate › Section 6.09 - Hearings

Current through Register 1525, July 5, 2024
(1) Appeals brought
			 to the Connector under either
			 956 CMR 6.06
			 or
			 6.07 will be
			 reviewed by the Connector. The Connector may approve or deny the appeal based
			 on the appeal request, documents, and other written materials that the
			 Appellant provides.
(2) The
			 Connector may dismiss any request for hearing if:
(a) it is not received within the time
			 periods specified in
			 956 CMR
			 6.07;
(b) it does not state a ground for appeal or
			 is not a valid ground for appeal under
			 956 CMR
			 6.08;
(c) the appeal is subject to dismissal under
			 801 CMR
			 1.02; or
(d) the appeal is withdrawn by the Appellant
			 or his representative.
Code of Massachusetts Regulations › 956 CMR - COMMONWEALTH HEALTH INSURANCE CONNECTOR AUTHORITY › Title 956 CMR 6.00 - Determining Affordability For The Individual Mandate › Section 6.10 - Administrative Information Bulletins

Current through Register 1525, July 5, 2024
The Connector may issue administrative information bulletins
				that set out policies that are consistent with the substantive provisions of
				956 CMR 6.00. In addition, the
				Connector may issue administrative information bulletins which specify the
				information and documentation necessary to implement
				956 CMR 6.00. The Connector
				may also issue administrative bulletins containing interpretations of
				956 CMR 6.00 and other
				information to assist persons subject to
				956 CMR 6.00 meet their
				obligations under
				956 CMR
				6.00.
Code of Massachusetts Regulations › 956 CMR - COMMONWEALTH HEALTH INSURANCE CONNECTOR AUTHORITY › Title 956 CMR 6.00 - Determining Affordability For The Individual Mandate › Section 6.11 - Severability of Provisions

Current through Register 1525, July 5, 2024
The provisions of
				956 CMR 6.00 are hereby
				declared to be severable. If any such provisions or the application of such
				provisions or circumstances shall be held invalid or unconstitutional, such
				invalidity shall not be construed to affect the validity or constitutionality
				of any remaining provisions of
				956 CMR 6.00 or the
				applications of such provisions or circumstances other than those held
				invalid.
Code of Massachusetts Regulations › 956 CMR - COMMONWEALTH HEALTH INSURANCE CONNECTOR AUTHORITY › Title 956 CMR 7.00 - Small Group Wellness Incentive Program › Section 7.01 - Purpose

Current through Register 1525, July 5, 2024
The purpose of
				956 CMR 7.00 is to implement
				the provisions of M.G.L. c. 176Q, § 7A.
				956 CMR 7.00 applies to the
				Small Group Wellness Incentive Program offered to certain employers by the
				Connector.
Code of Massachusetts Regulations › 956 CMR - COMMONWEALTH HEALTH INSURANCE CONNECTOR AUTHORITY › Title 956 CMR 7.00 - Small Group Wellness Incentive Program › Section 7.02 - Scope

Current through Register 1525, July 5, 2024
956 CMR 7.00 contains the
				Connector's regulations governing the operation of the Small Group Wellness
				Incentive Program, as specified in M.G.L. c. 176Q, § 7A. The Connector
				also promulgates other regulations and publishes other documents affecting its
				programs, including statements of policy and procedure, terms and conditions of
				participation, guidelines, administrative information bulletins and other
				documents as necessary.
Code of Massachusetts Regulations › 956 CMR - COMMONWEALTH HEALTH INSURANCE CONNECTOR AUTHORITY › Title 956 CMR 7.00 - Small Group Wellness Incentive Program › Section 7.03 - Definitions

Current through Register 1525, July 5, 2024
As used in
				956 CMR 7.00, the following
				terms shall mean:
Connector
. Commonwealth Health
				Insurance Connector Authority established under M.G.L. c. 176Q.
Director
. The Executive Director of
				the Connector.
Eligible Small Employer
. Any firm,
				corporation, partnership or association, including a tax-exempt organization,
				that purchases a group health plan through the Connector for at least one but
				not more than 25 Qualified Employees; provided, however, that an employer shall
				not be an Eligible Small Employer if the employer's sole owner is the only
				Qualified Employee of that employer.
Initially Enrolled Employees
. The
				number of Qualified Employees enrolled in the group health plan at the time the
				group health plan is purchased by the Eligible Small Employer through the
				Connector.
Qualified Employee
. Any employee of an
				Eligible Small Employer, including an owner or a partner in a partnership, who
				is covered in a group health plan purchased by an Eligible Small Employer
				through the Connector.
Rebate Payment
. A payment to an
				Eligible Small Employer who completes enrollment and participation requirements
				for the Small Group Wellness Incentive Program as set by the Connector pursuant
				to
				956 CMR
				7.04 and
				7.05.
Small Group Wellness Incentive
				Program
. The program authorized by M.G.L. c. 176Q, § 7A to
				expand the prevalence of employee wellness initiatives by small
				businesses.
Term
. The period beginning on the
				first of the month following an Eligible Small Employer's enrollment in the
				Connector's Small Group Wellness Incentive Program and extending for the
				subsequent 11 months.
Code of Massachusetts Regulations › 956 CMR - COMMONWEALTH HEALTH INSURANCE CONNECTOR AUTHORITY › Title 956 CMR 7.00 - Small Group Wellness Incentive Program › Section 7.04 - Enrollment Eligibility

Current through Register 1525, July 5, 2024
(1) To
			 enroll in the Small Group Wellness Incentive Program and be eligible for a
			 Rebate Payment, an employer must be an Eligible Small Employer.
Code of Massachusetts Regulations › 956 CMR - COMMONWEALTH HEALTH INSURANCE CONNECTOR AUTHORITY › Title 956 CMR 7.00 - Small Group Wellness Incentive Program › Section 7.05 - Rebate Payment

Current through Register 1525, July 5, 2024
(1) To qualify
			 for a Rebate Payment, an Eligible Small Employer shall:
(a) provide to the Connector, or its
			 designee, prior to the end of a Term, satisfactory documentation that the
			 Eligible Small Employer and at least 33% of the Eligible Small Employer's
			 Initially Enrolled Employees have met participation requirements for the Small
			 Group Wellness Incentive Program as set by the Connector; and
(b) provide to the Connector the information
			 needed to calculate the amount of the rebate, on a form and within a time
			 period specified by the Connector.
Code of Massachusetts Regulations › 956 CMR - COMMONWEALTH HEALTH INSURANCE CONNECTOR AUTHORITY › Title 956 CMR 7.00 - Small Group Wellness Incentive Program › Section 7.06 - Appeals

Current through Register 1525, July 5, 2024
(1) An employer may
			 appeal a decision by the Connector that the employer does not meet the
			 definition of an Eligible Small Employer, that the Eligible Small Employer has
			 not met the participation requirements set forth in
			 956 CMR
			 7.05(1), or that the
			 Connector's calculation of the amount of the Eligible Small Employer's Rebate
			 Payment is not correct.
(2) The
			 Connector shall provide written notice to the employer of an adverse decision
			 with respect to eligibility as an Eligible Small Employer, the Eligible Small
			 Employer's satisfaction of participation requirements as set forth in
			 956 CMR
			 7.05(1), or the amount of
			 the Eligible Small Employer's Rebate Payment.
(3) The employer must appeal the decision to
			 the Connector within 30 days after the receipt of the notice of the adverse
			 decision. In the absence of evidence to the contrary, the Connector will
			 presume that the notice was received on the third day after mailing. An
			 employer must appeal in writing on a form designated by the
			 Connector.
(4) Appeals brought to
			 the Connector under 956 CMR 7.06 will be heard by a hearing officer designated
			 by the Director. Hearings will be conducted using the policies and procedures
			 set forth for informal hearings pursuant to
			 801 CMR
			 1.02:
Formal Rules
or in any
			 administrative bulletins issued by the Connector pursuant to
			 956 CMR
			 7.07. The hearing may be conducted by
			 telephone. The decision may be made based solely on written submissions and
			 documents. The decision of the hearing officer will be the final decision of
			 the Connector.
(5) The Connector's
			 final decision on the appeal will be subject to an action for judicial review
			 under M.G.L. c. 30A, § 14.
Code of Massachusetts Regulations › 956 CMR - COMMONWEALTH HEALTH INSURANCE CONNECTOR AUTHORITY › Title 956 CMR 7.00 - Small Group Wellness Incentive Program › Section 7.07 - Administrative Information Bulletins

Current through Register 1525, July 5, 2024
The Connector may issue administrative information bulletins
				that set out policies that are consistent with the substantive provisions of
				956 CMR 7.00. In addition, the
				Connector may issue administrative information bulletins that specify the
				information and documentation necessary to implement
				956 CMR 7.00. The Connector
				may also issue administrative bulletins containing interpretations of
				956 CMR 7.00 and other
				information to assist persons in meeting the obligations under
				956 CMR
				7.00.
Code of Massachusetts Regulations › 956 CMR - COMMONWEALTH HEALTH INSURANCE CONNECTOR AUTHORITY › Title 956 CMR 7.00 - Small Group Wellness Incentive Program › Section 7.08 - Severability of Provisions

Current through Register 1525, July 5, 2024
The provisions of
				956 CMR 7.00 are hereby
				declared to be severable. If any such provisions or the application of such
				provisions or circumstances shall be held invalid or unconstitutional, such
				invalidity shall not be construed to affect the validity or constitutionality
				of any remaining provisions of
				956 CMR 7.00 or the
				application of such provisions or circumstances other than those held
				invalid.
Code of Massachusetts Regulations › 956 CMR - COMMONWEALTH HEALTH INSURANCE CONNECTOR AUTHORITY › Title 956 CMR 8.00 - Student Health Insurance Program › Section 8.01 - General Provisions

Current through Register 1525, July 5, 2024
(1)
Scope, Purpose and Effective Date
.
			 956 CMR 8.00 establishes the
			 requirements effective January 3, 2014, for Student Health Insurance Programs.
			 In accordance with M.G.L. c. 15A, § 18, Massachusetts Independent and
			 Public Institutions of Higher Education must ensure that all Students
			 participate in a Student Health Insurance Program or in a plan of comparable
			 coverage.
(2)
Authority
.
			 956 CMR 8.00 is promulgated in
			 accordance with the provisions of M.G.L. c. 15A, § 18.
Code of Massachusetts Regulations › 956 CMR - COMMONWEALTH HEALTH INSURANCE CONNECTOR AUTHORITY › Title 956 CMR 8.00 - Student Health Insurance Program › Section 8.03 - Mandatory Health Insurance Coverage

Current through Register 1525, July 5, 2024
(1)
Students
. Every Student enrolled in a certificate,
			 diploma or degree-granting program of higher education must participate in his
			 or her School's Student Health Insurance Program or in a Health Benefit Plan
			 with comparable coverage as defined in
			 956 CMR
			 8.05(2).
(2)
Schools
. Every
			 School shall offer a Student Health Insurance Program and shall require all
			 Students enrolled in a certificate, diploma or degree-granting program to
			 participate in the School's Student Health Insurance Program or in a Health
			 Benefit Plan with comparable coverage as defined in
			 956 CMR
			 8.05(2).
Code of Massachusetts Regulations › 956 CMR - COMMONWEALTH HEALTH INSURANCE CONNECTOR AUTHORITY › Title 956 CMR 8.00 - Student Health Insurance Program › Section 8.05 - Waiver of Participation Due to Comparable Coverage

Current through Register 1525, July 5, 2024
(1)
Election of Waiver of
			 Participation
. A School may elect to allow full-time and part-time
			 Students to waive participation in their School's Student Health Insurance
			 Program. Schools electing to allow waivers must:
(a) clearly communicate to their Students
			 information regarding the waiver process, the manner by which a Student may
			 request and obtain a waiver, and the deadlines associated with the waiver
			 process.
(b) require Students
			 waiving participation to certify, in writing, at least annually, as part of the
			 School's usual registration process that they are participating in a Health
			 Benefit Plan with comparable coverage pursuant to 956 CMR 8.05(3).
Code of Massachusetts Regulations › 956 CMR - COMMONWEALTH HEALTH INSURANCE CONNECTOR AUTHORITY › Title 956 CMR 8.00 - Student Health Insurance Program › Section 8.06 - Recordkeeping

Current through Register 1525, July 5, 2024
All Schools must maintain records sufficient to demonstrate
				compliance with
				956 CMR 8.00. These records
				must include, at a minimum, a copy of the School's Student Health Insurance
				Program offered to Students; a copy of the School's Student Health Insurance
				Program's Evidence of Coverage; all informational materials developed by or for
				the School to describe its Student Health Insurance Program; the Student's
				obligations to participate in his or her School's Student Health Insurance
				Program; and all written waiver requests submitted pursuant to
				956 CMR
				8.05(3). Such records must
				be maintained for at least three years.
Code of Massachusetts Regulations › 956 CMR - COMMONWEALTH HEALTH INSURANCE CONNECTOR AUTHORITY › Title 956 CMR 8.00 - Student Health Insurance Program › Section 8.07 - Reporting

Current through Register 1525, July 5, 2024
(1) By May
			 1st of each year, each School must report to the
			 Connector, in a manner specified by the Connector, the following information:
(a) the total number of Students enrolled in
			 the School who are required to participate in their School's Student Health
			 Insurance Program or in a Health Benefit Plan with comparable coverage for the
			 current School Year;
(b) from the
			 total number reported in 956 CMR 8.07(1)(a), the number who have waived
			 participation in their School's Student Health Insurance Program pursuant to
			 956 CMR
			 8.05 for the current School Year;
			 and
(c) performance metrics, such
			 as medical and administrative costs, the number of claim denials and
			 grievances, medical loss ratios, and other administration and performance
			 measures as specified by the Connector, pertaining to the Student Health
			 Insurance Program for the previous School Year.
(d) the following information for the current
			 School Year:
1. the name of the Carrier
			 underwriting the School's Student Health Insurance Program;
2. the premium cost per Student per year for
			 the School's Student Health Insurance Program;
3. any other health-related charges or fees
			 assessed to Students; and
4. a
			 description of the benefits, benefit levels, exclusions, limitations, and other
			 important terms and conditions of the School's Student Health Insurance Program
			 through the submission of marketing materials and the Evidence of Coverage for
			 the School's Student Health Insurance Program, provided that the Evidence of
			 Coverage has been approved by the Division of Insurance, and submission of the
			 benefit information. If the Evidence of Coverage has not been approved by the
			 Division of Insurance, the School must submit the Evidence of Coverage within
			 seven days of receiving approval from the Division of Insurance.
Code of Massachusetts Regulations › 956 CMR - COMMONWEALTH HEALTH INSURANCE CONNECTOR AUTHORITY › Title 956 CMR 8.00 - Student Health Insurance Program › Section 8.08 - Oversight and Enforcement

Current through Register 1525, July 5, 2024
(1)
Investigation, Review and Audit Procedures
. The
			 Connector may periodically investigate, review or audit the efforts of a School
			 in compliance with
			 956 CMR 8.00. A School must
			 make available to the Connector all records required to be maintained by the
			 School under
			 956 CMR
			 8.05 and
			 956 CMR 8.06 and
			 such other records, information and data that the Connector deems pertinent.
			 Upon or soon after the completion of its investigation, review or audit, the
			 Connector will confer with the School to describe the investigation, review or
			 audit process itself, to discuss any conclusions and recommendations under
			 consideration by the Connector and to offer or obtain additional pertinent
			 information. Upon completion of its written report, the Connector will forward
			 a copy to the School.
(2)
Enforcement Process
. If the Connector determines,
			 after investigation, review or audit, that a School has failed to comply with
			 956 CMR 8.00 and that a
			 sanction authorized under
			 956 CMR 8.11 should
			 be imposed, the Connector must issue a Notice of Action. The Notice of Action
			 must specify the facts relied upon in making this determination, cite any
			 statute or regulation which authorizes the Connector to take the action, and
			 inform the School of its right to an adjudicatory hearing. An adjudicatory
			 hearing under
			 956 CMR 8.00 is governed by
			 the rules of practice and procedure set forth in
			 801 CMR 1.01:
Formal Rules
and 1.03:
Miscellaneous Provisions
			 Applicable to All Adjudicatory Proceedings
.
Code of Massachusetts Regulations › 956 CMR - COMMONWEALTH HEALTH INSURANCE CONNECTOR AUTHORITY › Title 956 CMR 8.00 - Student Health Insurance Program › Section 8.09 - Sanctions

Current through Register 1525, July 5, 2024
Each School which fails to meet its obligations under
				956 CMR 8.00, including
				maintenance of required documentation and reporting requirements, must pay a
				penalty of at least $35 or $5 for each Student, whichever is greater, for every
				day the failure continues.
Code of Massachusetts Regulations › 956 CMR - COMMONWEALTH HEALTH INSURANCE CONNECTOR AUTHORITY › Title 956 CMR 8.00 - Student Health Insurance Program › Section 8.10 - Administrative Bulletins

Current through Register 1525, July 5, 2024
The Connector may periodically issue administrative bulletins
				containing interpretations of
				956 CMR 8.00 and other
				information to assist Schools to meet their obligations under
				956 CMR
				8.00.
Code of Massachusetts Regulations › 956 CMR - COMMONWEALTH HEALTH INSURANCE CONNECTOR AUTHORITY › Title 956 CMR 8.00 - Student Health Insurance Program › Section 8.11 - Severability

Current through Register 1525, July 5, 2024
If any section or portion of sections of
				956 CMR 8.00, or the
				applicability thereof to any person or circumstances is held invalid by any
				court of competent jurisdiction, the remainder of
				956 CMR 8.00, or the
				applicability thereof to other persons or circumstances, will not be affected
				thereby.
Code of Massachusetts Regulations › 956 CMR - COMMONWEALTH HEALTH INSURANCE CONNECTOR AUTHORITY › Title 956 CMR 9.00 - Employer Surcharge For State Funded Health Costs › Section 9.01 - General Provisions

Current through Register 1525, July 5, 2024
Scope and Purpose
.
				956 CMR 9.00 governs the
				surcharge assessed on Employers that do not comply with the requirements of
				M.G.L. c. 151F to adopt and maintain a Section 125 Cafeteria Plan for payroll
				deductions for health insurance premiums in accordance with Commonwealth Health
				Insurance Connector regulations at 956 CMR 4.00:
Employer Sponsored
				Health Insurance Access.
The surcharge is assessed for State Funded
				Health Costs incurred for its Employees or Employee Dependents not offered
				participation in the Employer's Section 125 Cafeteria Plan.
Code of Massachusetts Regulations › 956 CMR - COMMONWEALTH HEALTH INSURANCE CONNECTOR AUTHORITY › Title 956 CMR 9.00 - Employer Surcharge For State Funded Health Costs › Section 9.03 - Employers Subject to Surcharge

Current through Register 1525, July 5, 2024
(1)
General
. An Employer is subject to surcharge if:
(a) it is a Non-providing Employer determined
			 in accordance with 956 CMR 9.03(2); and
(b) any of its Employees are State funded
			 Employees determined in accordance with 956 CMR 9.03(3); and
(c) its State funded Employees receive State
			 funded Health Services that total at least $50,000 in a fiscal year as
			 determined in accordance with 956 CMR 9.03(4).
Code of Massachusetts Regulations › 956 CMR - COMMONWEALTH HEALTH INSURANCE CONNECTOR AUTHORITY › Title 956 CMR 9.00 - Employer Surcharge For State Funded Health Costs › Section 9.04 - Determination of Surcharge Amount

Current through Register 1525, July 5, 2024
(1)
General
. The Connector will determine the Surcharge
			 amount by taking into account:
(a) the number
			 of Employees of the Employer;
(b)
			 the number of admissions and visits for each State funded Employee;
(c) the total State funded Health Services
			 attributed to the Employer's State Funded Employees as determined under
			 956 CMR
			 9.03(4); and
(d) the percentage of Employees for whom the
			 Employer provides health insurance.
Code of Massachusetts Regulations › 956 CMR - COMMONWEALTH HEALTH INSURANCE CONNECTOR AUTHORITY › Title 956 CMR 9.00 - Employer Surcharge For State Funded Health Costs › Section 9.05 - Collection of Surcharge

Current through Register 1525, July 5, 2024
(1)
Notification of Surcharge Liability
. The Connector
			 will notify Employers subject to Surcharge at the end of each Fiscal Year. The
			 Notice will contain the following information:
(a) Employer name, FEIN, address;
(b) Name of State funded Employee. If
			 Employee dependent, name of Employee;
(c) Name of provider that submitted
			 claim;
(d) Dates of
			 service;
(e) Provider
			 charges;
(f) Amount of State funded
			 Health Costs per State funded Employee;
(g) Total Amount of State funded Health
			 Costs;
(h) Surcharge Amount
			 determined in accordance with
			 956 CMR
			 9.04;
(i) Date payment is due;
(j) Remittance advice with directions to
			 submit payment.
Code of Massachusetts Regulations › 956 CMR - COMMONWEALTH HEALTH INSURANCE CONNECTOR AUTHORITY › Title 956 CMR 9.00 - Employer Surcharge For State Funded Health Costs › Section 9.06 - Other Provisions

Current through Register 1525, July 5, 2024
(1) No Employer
			 shall discriminate against any Employee on the basis of the Employee's receipt
			 of free care, the Employee's reporting or disclosure of his Employer's identity
			 and other information about the Employer, the Employee's completion of a Health
			 Insurance Responsibility Disclosure form, or any facts or circumstances
			 relating to "free rider" surcharges assessed against the Employer in relation
			 to the Employee. Violation of 956 CMR 9.06(1) shall constitute a per se
			 violation of M.G.L. c. 93A.
(2)
Reporting Requirements
. Each Employer shall file or
			 make available information which is required or which the Connector deems
			 reasonably necessary for calculating and collecting the Employer
			 Surcharge.
(3)
Notice
			 Requirements
. An acute hospital or community health center will
			 include a notice in all written Collection Actions that the Connector may
			 provide information about state funded services to Employers and that Employers
			 may be liable for services Employees receive.
(4)
Penalties
. If an
			 Employer fails to file any data, statistics or schedules or other information
			 required under
			 956 CMR 9.00 or by any
			 regulation promulgated by the Connector, the Connector shall provide written
			 notice of the required information. If the Employer fails to provide
			 information within two weeks of receipt of said notice, or if it falsifies the
			 same, it shall be subject to a civil penalty of not more than $5,000 for each
			 week on which such violation occurs or continues, which penalty may be assessed
			 in an action brought on behalf of the commonwealth in any court of competent
			 jurisdiction.
(5)
Administrative Information Bulletins
. The Connector
			 may issue administrative information bulletins to clarify policies, update
			 administrative requirements and specify information and documentation necessary
			 to implement
			 956 CMR 9.00.
(6)
Severability
.
			 The provisions of
			 956 CMR 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
			 956 CMR 9.00 or the
			 application of such provisions.
Code of Massachusetts Regulations › 956 CMR - COMMONWEALTH HEALTH INSURANCE CONNECTOR AUTHORITY › Title 956 CMR 10.00 - Health Insurance Responsibility Disclosure › Section 10.01 - General Provisions

Current through Register 1525, July 5, 2024
Scope and Purpose
.
				956 CMR 10.00 governs the
				filing requirements for the Health Insurance Responsibility Disclosure Form.
				Each Massachusetts Employer with 11 or more Full Time Equivalent Employees is
				required to file information about its compliance with the M.G.L. c. 151F
				requirement to adopt and maintain a Section 125 Cafeteria Plan. Each Employee
				of a Massachusetts Employer with 11or more Full Time Equivalent Employees that
				declines the Employer's offer of health insurance or declines to use the
				Employer's Section 125 Cafeteria Plan to purchase other health insurance is
				required to sign an Employee HIRD form.
Code of Massachusetts Regulations › 956 CMR - COMMONWEALTH HEALTH INSURANCE CONNECTOR AUTHORITY › Title 956 CMR 10.00 - Health Insurance Responsibility Disclosure › Section 10.03 - Employer HIRD Report

Current through Register 1525, July 5, 2024
(1)
General Requirements
. Each Massachusetts Employer with
			 eleven or more Full Time Equivalent Employees shall report the following
			 information in an Employer HIRD Report specified by the Connector.
(a)
Reporting
			 Employer
. An Employer has 11 or more Full Time Equivalent
			 Employees if the sum of total payroll hours for all Employees for a calendar
			 quarter, divided by 500, is greater than or equal to 11. In calculating payroll
			 hours:
1. For each Employee with more than 500
			 payroll hours for the Employer, the Employer shall include 500 payroll
			 hours.
2. Payroll hours include all
			 hours for which an Employer paid wages including, but not limited to, regular,
			 vacation, sick, Federal Medical Leave of Absence, short term disability, long
			 term disability, overtime and holiday hours.
3. The Employer shall include the payroll
			 hours of Seasonal Employees but shall not include the payroll hours of
			 Independent Contractors as defined in
			 956 CMR
			 10.02.
4. An Employer who is determined to be a
			 successor under M.G.L. c. 151A shall include the payroll hours of the
			 predecessor's Employees during the determination period.
Code of Massachusetts Regulations › 956 CMR - COMMONWEALTH HEALTH INSURANCE CONNECTOR AUTHORITY › Title 956 CMR 10.00 - Health Insurance Responsibility Disclosure › Section 10.04 - Employee HIRD Form

Current through Register 1525, July 5, 2024
(1)
General Requirements
. Each Reporting Employer must
			 provide an Employee HIRD Form for completion and signature by each Employee
			 that declines to enroll in Employer-sponsored insurance or declines to use the
			 Employer's Section 125 Cafeteria Plan to pay for health insurance. Each time an
			 Employee of a Reporting Employer declines to enroll in Employer sponsored
			 insurance or declines to use the Reporting Employer's Section 125 Plan to pay
			 for health insurance, the Employee is required to complete, sign and return an
			 Employee HIRD Form to the Reporting Employer.
(a)
Reporting
			 Employer
. An employer is required to collect signed Employee HIRD
			 Forms if it has either 5,500 payroll hours in any quarter or 22,000 payroll
			 hours in a year.
(b)
Required Information
. The Employee HIRD Form must
			 contain the following information:
1. Employee
			 Name;
2. Employer Name;
3. Whether the Employee was informed about
			 the Employer's Section 125 Cafeteria Plan;
4. Whether the Employee declined to use the
			 Employer's Section 125 Cafeteria Plan to pay for health insurance;
5. Whether the Employee was offered Employer
			 subsidized health insurance;
6.
			 Whether the Employee declined to enroll in Employer subsidized health
			 insurance;
7. If the Employee
			 declined Employer subsidized health insurance, the dollar amount of employee's
			 portion of the monthly premium cost of the least expensive individual health
			 plan offered by the Employer to the Employee;
8. Whether the Employee has alternative
			 insurance coverage;
9. The
			 Employee's signature and the date on which the Employee signs the HIRD
			 form.
(c)
Required Acknowledgments
.
1. The Employee must acknowledge that he or
			 she has declined to enroll in Employer sponsored insurance and/or has declined
			 to use the Employer's Section Cafeteria 125 Plan to pay for health
			 insurance.
2. The Employee must
			 acknowledge that if he or she declines an Employer offer of subsidized health
			 insurance, he or she may be liable for his or her health care costs.
3. The Employee must acknowledge that he or
			 she is aware of the individual mandate under M.G.L. c. 111M and the penalties
			 for failure to comply with the individual mandate.
4. The Employee must acknowledge that he or
			 she is required to maintain a copy of the signed HIRD Form and that the HIRD
			 Form contains information that must be reported in the Employee's Massachusetts
			 tax return.
5. The Employee must
			 indicate that by his or her signature, he or she acknowledges the truthfulness
			 of his or her answers.