reglab/statecodes huggingface dataset:
Code of Massachusetts Regulations › 211 CMR - DIVISION OF INSURANCE › Title 211 CMR 31.00 - Life Insurance Solicitation › Section 31.06 - Pre-need Funeral Contracts and Arrangements

Current through Register 1525, July 5, 2024
The following information shall be adequately disclosed at the
				time an application is made, prior to accepting the applicant's initial premium
				or deposit; for a pre-need funeral contract and arrangement that is funded or
				to be funded by a life insurance policy:
(1) The fact that a life insurance policy is
			 involved or being used to fund an arrangement;
(2) The nature of the relationship among the
			 soliciting producer or producers, the provider of the funeral or cemetery
			 merchandise or services, the administrator and any other person;
(3) The relationship of the life insurance
			 policy to the funding of the arrangement and the nature and existence of any
			 guarantees relating to the arrangement;
(4) The impact on the arrangement:
(a) Of any changes in the life insurance
			 policy including but not limited to, changes in the assignment, beneficiary
			 designation or use of the proceeds;
(b) Of any penalties to be incurred by the
			 policyholder as a result of failure to make premium payments;
(c) Of any penalties to be incurred or monies
			 to be received as a result of cancellation or surrender of the life insurance
			 policy;
Code of Massachusetts Regulations › 211 CMR - DIVISION OF INSURANCE › Title 211 CMR 31.00 - Life Insurance Solicitation › Section 31.07 - General Rules

Current through Register 1525, July 5, 2024
(1) Each insurer
			 shall maintain at its home office or principal office, a complete file
			 containing one copy of each form authorized by the insurer for use pursuant to
			 211
			 CMR 31.00. Such file shall contain one copy of each
			 authorized form for a period of three years following the date of its last
			 authorized use unless otherwise provided by
			 211
			 CMR 31.00.
(2) An insurance producer shall inform the
			 prospective purchaser, prior to commencing a life insurance sales presentation,
			 that he is acting as an insurance producer and inform the prospective purchaser
			 of the full name of the insurance company which he is representing to the
			 buyer. In sales situations in which an insurance producer is not involved, the
			 insurer shall identify its full name.
(3) Terms such as financial planner,
			 investment advisor, financial consultant, or financial counseling shall not be
			 used in such a way as to imply that the insurance producer is primarily engaged
			 in an advisory business in which compensation is unrelated to sales unless such
			 is actually the case. This provision is not intended to preclude persons who
			 hold some form of formal recognized financial planning or consultant
			 designation from using this designation even when they are only selling
			 insurance. This provision also is not intended to preclude persons who are
			 members of a recognized trade or professional association having such terms as
			 part of its name from citing membership, providing that a person citing
			 membership, if authorized only to sell insurance products, shall disclose that
			 fact. This provision does not permit persons to charge an additional fee for
			 services that are customarily associated with the solicitation, negotiation or
			 servicing of policies.
(4) Any
			 reference to nonguaranteed elements must include a statement that the item is
			 not guaranteed and is based on the company's current scale of nonguaranteed
			 elements. If a nonguaranteed element would be reduced by the existence of a
			 policy loan, a statement to that effect shall be included in any reference to
			 nonguaranteed elements. A presentation or depiction of a policy issued after
			 the effective date of
			 211
			 CMR 28.00 that includes nonguaranteed elements over a
			 period of years shall be governed by
			 211
			 CMR 28.00.
(5) For the purposes of
			 211
			 CMR 31.00, the company must show the maximum annual
			 premium if it reserves the right to change the premium.
Code of Massachusetts Regulations › 211 CMR - DIVISION OF INSURANCE › Title 211 CMR 31.00 - Life Insurance Solicitation › Section 31.08 - Failure to Comply

Current through Register 1525, July 5, 2024
Failure of an insurer to provide or deliver a Buyer's Guide, an
				in force illustration, a policy summary or policy data as provided in
				211 CMR 31.05
				shall constitute an omission which misrepresents the benefits, advantages,
				conditions or terms of an insurance policy.
Code of Massachusetts Regulations › 211 CMR - DIVISION OF INSURANCE › Title 211 CMR 31.00 - Life Insurance Solicitation › Section 31.09 - Severability

Current through Register 1525, July 5, 2024
If any provision of
				211
				CMR 31.00 or its application to any person or
				circumstance is for any reason held to be invalid by any court of law, the
				remainder of the regulation and its application to other persons or
				circumstances shall not be affected.
Code of Massachusetts Regulations › 211 CMR - DIVISION OF INSURANCE › Title 211 CMR 32.00 - Use Of Gender-blended And Smoker/nonsmoker Mortality Tables › Section 32.01 - Authority

Current through Register 1525, July 5, 2024
211 CMR 32.00 is promulgated
				pursuant to the authority vested in the Commissioner of Insurance by M.G.L. c.
				175, § 9 and 144.
Code of Massachusetts Regulations › 211 CMR - DIVISION OF INSURANCE › Title 211 CMR 32.00 - Use Of Gender-blended And Smoker/nonsmoker Mortality Tables › Section 32.02 - Purpose

Current through Register 1525, July 5, 2024
The purpose of
				211 CMR 32.00 is:
(a) to permit individual life insurance
			 policies to provide the same cash values and paid-up nonforfeiture benefits to
			 both men and women, without change in minimum valuation standards;
			 and
(b) to permit the use of
			 mortality tables that reflect differences in mortality between smokers and
			 nonsmokers in determining minimum cash surrender values, paid-up nonforfeiture
			 benefits, and minimum reserve liabilities for plans of insurance with separate
			 premium rates for smokers and nonsmokers.
Code of Massachusetts Regulations › 211 CMR - DIVISION OF INSURANCE › Title 211 CMR 32.00 - Use Of Gender-blended And Smoker/nonsmoker Mortality Tables › Section 32.03 - Applicability and Scope

Current through Register 1525, July 5, 2024
211 CMR 32.00 shall apply to
				all individual life insurance policies. The requirements contained in
				211 CMR 32.00 shall be in
				addition to any other applicable statutory provisions or lawful regulations.
				211 CMR 32.00 includes
				provisions on smoker/nonsmoker mortality tables that were previously set forth
				at 211 CMR 33.00.
Code of Massachusetts Regulations › 211 CMR - DIVISION OF INSURANCE › Title 211 CMR 32.00 - Use Of Gender-blended And Smoker/nonsmoker Mortality Tables › Section 32.05 - Rule for Gender-Blended Mortality Tables

Current through Register 1525, July 5, 2024
(1) For any policy of insurance on the life
			 of either a male or female insured delivered or issued for delivery in the
			 Commonwealth after the operative date of M.G.L. c. 175, § 144 (6A)(k) for
			 that policy form,
(a) a mortality table which
			 is a blend of the 1980 CSO Table (M) and 1980 CSO Table (F) with or without
			 Ten-Year Select Mortality Factors may at the option of the company be
			 substituted for the 1980 CSO Table, with or without Ten-Year Select Mortality
			 Factors, and
(b) a mortality table
			 which is of the same blend as used in 211 CMR 32.05(1)(a) but applied to form a
			 blend of the 1980 CET Table (M) and 1980 CET Table (F) may at the option of the
			 company be substituted for the 1980 CET Table for use in determining minimum
			 cash surrender values and amounts of paid-up nonforfeiture benefits.
Code of Massachusetts Regulations › 211 CMR - DIVISION OF INSURANCE › Title 211 CMR 32.00 - Use Of Gender-blended And Smoker/nonsmoker Mortality Tables › Section 32.06 - Rule for Smoker/Nonsmoker Mortality Tables

Current through Register 1525, July 5, 2024
(1)
Alternate
			 Tables.
(a) For any policy of
			 insurance delivered or issued for delivery in this state after the effective
			 date of former 211 CMR 33.00 in 1985,
1. the
			 1980 CSO Smoker and Nonsmoker Mortality Tables, with or without Ten-Year Select
			 Mortality Factors, may be substituted for the 1980 CSO Table, with or without
			 Ten-Year Select Mortality Factors, or for the 1958 CSO Table, and
2. the 1980 CET Smoker and Nonsmoker
			 Mortality Tables may be substituted for the 1980 CET Table or for the 1958 CET
			 Table.
Code of Massachusetts Regulations › 211 CMR - DIVISION OF INSURANCE › Title 211 CMR 32.00 - Use Of Gender-blended And Smoker/nonsmoker Mortality Tables › Section 32.07 - Separability

Current through Register 1525, July 5, 2024
If any provision of
				211 CMR 32.00 or the
				application thereof to any person or circumstance is for any reason held to be
				invalid, the remainder of
				211 CMR 32.00 and the
				application of such provision to other persons or circumstances shall not be
				affected thereby.
Code of Massachusetts Regulations › 211 CMR - DIVISION OF INSURANCE › Title 211 CMR 32.00 - Use Of Gender-blended And Smoker/nonsmoker Mortality Tables › Section 32.08 - Effective Date

Current through Register 1525, July 5, 2024
The effective date of
				211 CMR 32.00, as amended, is
				December 27, 1996.
Code of Massachusetts Regulations › 211 CMR - DIVISION OF INSURANCE › Title 211 CMR 34.00 - The Replacement Of Life Insurance And Annuities › Section 34.01 - Purpose

Current through Register 1525, July 5, 2024
The purpose of
				211 CMR 34.00 is:
(1) To regulate the activities of insurers,
			 agents and brokers with respect to the replacement of existing life insurance
			 and annuities.
(2) To protect the
			 interests of life insurance and annuity purchasers by establishing minimum
			 standards of conduct to be observed in replacement transactions by:
(a) Assuring that purchasers receive
			 information with which a decision can be made in his or her own best
			 interest:
(b) Reducing the
			 opportunity for misrepresentation and incomplete disclosures; and
(c) Establishing penalties for failure to
			 comply with requirements of
			 211 CMR 34.00.
Code of Massachusetts Regulations › 211 CMR - DIVISION OF INSURANCE › Title 211 CMR 34.00 - The Replacement Of Life Insurance And Annuities › Section 34.02 - Definitions

Current through Register 1525, July 5, 2024
The following words as used in
				211 CMR 34.01 through
				34.08, inclusive,
				shall, unless the context clearly requires otherwise, have the following
				meanings:
Conservation
, any attempt by
				theexistinginsureror its agent or broker to dissuade a policy owner from the
				replacement of existing life insurance or annuity. Conservation does not
				include routine administrative procedures such as late payment reminders, late
				payment offers or reinstatement offers.
Direct-response sales
, any sale of
				life insurance or annuity where the insurer does not utilize an agent in the
				sale or delivery of the policy.
Existing insurer
, the insurance
				company whose policy is or will be changed or terminated as provided in the
				definition of "replacement".
Existing life insurance or annuity
,
				any life insurance or annuity in force, including life insurance under a
				bindingor conditionalreceipt or a life insurance policy or annuity that is
				within an unconditional refund period.
Registered contract
, variable
				annuities, investment annuities, variable life insurance under which the death
				benefits and cash values vary in accordance with unit values of investments
				held in a separate account, or any other contracts issued bylife insurance
				companies which are registered with the federal Securities and Exchange
				Commission.
Replacement
, any transaction in which
				new life insurance or a new annuity is to be purchased, and it is known or
				should be known to the proposing agent or broker or to the proposing insurer if
				there is no agent, that by reason of such transaction, existing life insurance
				or annuity has been or is to be:
(a) lapsed, forfeited, surrendered or otherwise
				terminated;
(b) converted to reduced paid-up insurance, continued as
				extended term insurance, or otherwise reduced in value by the use of
				nonforfeiture benefits or other policy values;
(c) amended so as to effect either a reduction in benefits or
				in the term for which coverage would otherwise remain in force or for which
				benefits would be paid;
(d) reissued with any reduction in cash value; or
(e) pledged as collateralor subjected to borrowing, whether in
				a single loan or under a schedule of borrowing over a period oftime for amounts
				in the aggregate exceeding 25% of the loan value set forth in the
				policy.
Replacing insurer
, the insurance
				company that issues or proposes to issue a new policy or contract which is a
				replacement of existing life insurance or annuity.
Code of Massachusetts Regulations › 211 CMR - DIVISION OF INSURANCE › Title 211 CMR 34.00 - The Replacement Of Life Insurance And Annuities › Section 34.03 - Exemptions

Current through Register 1525, July 5, 2024
(1) Unless otherwise specifically included,
			 211 CMR 34.01, 34.03
			 through
			 34.08 inclusive, shall
			 not apply to transactions involving:
(a)
			 credit life insurance;
(b) group
			 life insurance or group annuities;
(c) proposed life insurance that is to
			 replace life insurance under a binding or conditional receipt issued by the
			 same company;
(d) internal
			 replacements where the replacing insurer and the existing insurer are the same,
			 or are subsidiaries or affiliates under common ownership or control; provided,
			 however, that agents or brokers proposing replacement shall comply with the
			 requirements of agents who initiate the application;
(e) insurance paid for wholly or partly by
			 the insured's employer or by an association of which the insured is a member,
			 or insurance in a qualified pension, profit sharing or other benefit
			 plan;
(f) life insurance policies
			 issued in connection with a pension, profit sharing or other benefit plan
			 qualifying for tax deductibility of premiums.
Code of Massachusetts Regulations › 211 CMR - DIVISION OF INSURANCE › Title 211 CMR 34.00 - The Replacement Of Life Insurance And Annuities › Section 34.04 - Duties of Agents and Brokers

Current through Register 1525, July 5, 2024
(1) Each agent or
			 broker who initiates the application shall submit to the insurer to which an
			 application for life insurance or annuity is presented, with or as part of each
			 application:
(a) a statement signed by the
			 applicant as to whether replacement of existing life insurance or annuity is
			 involved in the transaction; and
(b) a signed statement as to whether the
			 agent or broker knows replacement is or may be involved in the
			 transaction.
Code of Massachusetts Regulations › 211 CMR - DIVISION OF INSURANCE › Title 211 CMR 34.00 - The Replacement Of Life Insurance And Annuities › Section 34.05 - Duties of Insurers

Current through Register 1525, July 5, 2024
(1) Each insurer
			 shall:
(a) inform its representatives or
			 other personnel responsible for compliance with
			 211 CMR 34.00 of the
			 requirements of
			 211 CMR 34.00; and
(b) require with or as a part of each
			 completed application for life insurance or annuity a statement signed by the
			 applicant as to whether such proposed insurance or annuity will replace
			 existing life insurance or annuity.
(c) provide the yield index figures requested
			 by the applicant pursuant to the Notice required in
			 211 CMR 34.04(2)(a)
			  when electing to provide such yield index
			 figures to applicants.
Code of Massachusetts Regulations › 211 CMR - DIVISION OF INSURANCE › Title 211 CMR 34.00 - The Replacement Of Life Insurance And Annuities › Section 34.07 - Duties of Insurers with Respect to Direct Response Sales

Current through Register 1525, July 5, 2024
(1) If in the solicitation of a direct
			 response sale, the insurer did not propose the replacement, and a replacement
			 is involved, the insurer shall send to the applicant the notice regarding
			 replacement or other substantially similar form approved by the commissioner.
			 In such instances the insurer may delete the last sentence and the references
			 to signatures from such notice without having to obtain approval of the form
			 from the commissioner.
(2) If the
			 insurer proposed the replacement it shall:
(a) provide to applicants or prospective
			 applicants with or as part of the application a notice regarding replacement or
			 other substantially similar form approved by the commissioner;
(b) request from the applicant with or as
			 part of the application, a list of all existing life insurance or annuity to be
			 replaced and properly identified by name of insurer and insured; and
(c) send to each existing insurer a written
			 communication advising of the replacement or proposed replacement and the
			 identification information obtained, pursuant to
			 211 CMR
			 34.06(1)(b)1. of an
			 insurer's responsibility where a replacement is involved, and a policy summary
			 as defined in the Life Insurance Solicitation Regulation,
			 211 CMR
			 31.04.
Code of Massachusetts Regulations › 211 CMR - DIVISION OF INSURANCE › Title 211 CMR 34.00 - The Replacement Of Life Insurance And Annuities › Section 34.08 - Penalties

Current through Register 1525, July 5, 2024
(1) A violation of
			 211 CMR 34.01 through
			 34.08 inclusive, shall occur If an agent, broker or insurer recommends the
			 replacement or conservation of an existing policy by use of a substantially
			 inaccurate or incomplete presentation or comparison of an existing contract's
			 premiums and benefits or dividends and values, if any. Any comparison of a
			 participating policy that does not include projected dividends based upon the
			 most recent dividend scale applicable to the participating policy shall be
			 presumed to be an incomplete comparison in violation of 211 CMR 34.08. The
			 above presumption shall not apply to any agent or company that has made written
			 request for such dividend information from the company that issued the
			 participating policy if such information is not received within seven working
			 days of such request.
(2) A pattern
			 of action by a policy owner who purchases replacing policies from the same
			 agent or broker, after indicating on applications that replacement is not
			 involved, shall be deemed
prima facie
evidence of the agent's
			 or broker's knowledge that replacement was intended in connection with sale of
			 those policies, and such patterns of action shall be deemed prima facie
			 evidence of the agent's or broker's intent to violate the provisions of
			 211 CMR 34.01 through
			 34.08, inclusive.
(3) A replacement
			 of life insurance or annuity which is not transacted pursuant to the
			 requirements of
			 211 CMR 34.01 through
			 34.08 inclusive, is hereby defined as an unfair method of competition and
			 unfair or deceptive acts or practices in the business of insurance.
Code of Massachusetts Regulations › 211 CMR - DIVISION OF INSURANCE › Title 211 CMR 36.00 - The Use Of Aids-related Information For Life And Health Insurance And Informed Consent › Section 36.01 - Purpose and Scope

Current through Register 1525, July 5, 2024
The purpose of
				211 CMR 36.00 is to ensure
				that individuals who seek or obtain life and health insurance coverage
				(including disability insurance coverage) are not unfairly discriminated
				against, are fully informed of the extent to which HIV-related information is
				used by carriers, of the implications of HIV-related testing and to ensure that
				the confidentiality of such information is maintained by carriers, insurance
				producers and those persons or entities that act on their behalf in connection
				with insurance transactions.
				211 CMR 36.00 applies to any
				testing for HIV or use of HIV-related information for insurance
				purposes.
Code of Massachusetts Regulations › 211 CMR - DIVISION OF INSURANCE › Title 211 CMR 36.00 - The Use Of Aids-related Information For Life And Health Insurance And Informed Consent › Section 36.03 - Prohibited Practices

Current through Register 1525, July 5, 2024
(1) HIV-related
			 information must be treated as highly confidential. No carrier, insurance
			 producer or employee thereof shall communicate information regarding an HIV
			 test, the results of any such test or any other HIV- related information to any
			 person, unless such communication is lawful and such communication is made with
			 the written authorization of the individual to whom the information
			 relates.
(2) No carrier shall
			 request or require that an individual undergo an HIV test unless the carrier
			 has obtained prior written informed consent from the individual in compliance
			 with the requirements of
			 211 CMR
			 36.04.
(3) A carrier may request or require an
			 individual to submit to an HIV test only on a basis that is not unfairly
			 discriminatory.
(4) A carrier or
			 insurance producer which learns or has reason to believe that its employee or
			 any other person acting with authority on its behalf has violated the
			 provisions of
			 211 CMR 36.00 shall
			 immediately investigate the situation and take such prompt disciplinary,
			 enforcement or other corrective action as may be required. Carriers and
			 insurance producers shall maintain records of such violations and the
			 corrective actions taken in a file which shall be made available to the
			 Division of Insurance upon its request.
(5) A carrier or insurance producer shall
			 comply with the procedures and practices set forth when informed consent is
			 obtained pursuant to
			 211 CMR 36.00.
Code of Massachusetts Regulations › 211 CMR - DIVISION OF INSURANCE › Title 211 CMR 36.00 - The Use Of Aids-related Information For Life And Health Insurance And Informed Consent › Section 36.05 - Disclosure of Positive Test Results to Tested Individual

Current through Register 1525, July 5, 2024
(1) A carrier which requires or requests that
			 any individual submit to an HIV test shall notify that individual of a positive
			 test result as expeditiously as possible, but in no event later than 45 days
			 after the individual's blood sample is taken. Such test result disclosure shall
			 be made in either of the following ways, at the option of the individual:
(a)
Notification Through the
			 Designated Physician
. A carrier may encourage an individual to
			 obtain results through his or her physician rather than directly. If the
			 individual selects this option and authorizes disclosure of the positive test
			 result to a physician, and has not informed the carrier in writing of a
			 revocation of the election, the carrier shall send the HIV test results to the
			 designated physician, together with the following statement regarding the
			 confidentiality of HIV test results:
In addition to any current privacy safeguards applying to
				medical information generally, Massachusetts state law prohibits you
				from:
1.disclosing the results of HIV
			 tests to any person other than the individual tested without first obtaining
			 that individual's written informed consent; and
2.identifying the individual tested to any
			 person without first obtaining that individual's written informed
			 consent.
Code of Massachusetts Regulations › 211 CMR - DIVISION OF INSURANCE › Title 211 CMR 36.00 - The Use Of Aids-related Information For Life And Health Insurance And Informed Consent › Section 36.06 - Carrier Confidentiality Requirements

Current through Register 1525, July 5, 2024
(1) A
			 carrier shall implement reasonable internal safeguards to protect the privacy
			 of HIV-related information including any request that an individual submit to
			 an HIV test, the carrier's basis for requesting such a test, any refusal or
			 agreement to submit to a test, and any HIV test result. These internal
			 confidentiality standards shall meet the following minimum requirements:
(a) the standards shall be in writing, and
			 shall be available to the Division upon request;
(b) the carrier shall designate a specific
			 person(s) to have responsibility for maintaining the confidentiality of
			 HIV-related information;
(c) each
			 employee, insurance producer or other person or entity authorized to act on
			 behalf of the carrier who may have access to HIV-related information shall be
			 informed in writing of the carrier's confidentiality standards to the extent
			 reasonably necessary to protect the confidentiality of the HIV- related
			 information;
(d) the standards
			 shall specify that no person shall have access to HIV- related information
			 except those persons designated in accordance with
			 211 CMR 36.00;
(e) the standards shall ensure that
			 HIV-related information, whether stored in electronic or paper format, is
			 protected by reasonable security safeguards; and
(f) the standards shall ensure that
			 HIV-related information shall be accessible only to the minimum necessary
			 number of those persons or entities designated to have access pursuant to
			 211 CMR
			 36.04(2)(a)4., 5. and (3)(c)
			 and (d).
Code of Massachusetts Regulations › 211 CMR - DIVISION OF INSURANCE › Title 211 CMR 36.00 - The Use Of Aids-related Information For Life And Health Insurance And Informed Consent › Section 36.07 - Applications

Current through Register 1525, July 5, 2024
(1) Carriers and insurance producers are
			 prohibited from requesting any information related to:
(a) counseling about HIV or AIDS;
			 or
(b) the sexual orientation of
			 the individual, or any applicant, proposed insured, policyholder or
			 beneficiary, including questions relating to proxies for sexual
			 orientation.
Code of Massachusetts Regulations › 211 CMR - DIVISION OF INSURANCE › Title 211 CMR 36.00 - The Use Of Aids-related Information For Life And Health Insurance And Informed Consent › Section 36.08 - Penalties

Current through Register 1525, July 5, 2024
(1) A violation of any provisions of
			 211 CMR 36.00 by any carrier,
			 insurance producer or employee, authorized agent or representative thereof,
			 shall be considered to be an unfair or deceptive act or practice on the part of
			 such carrier, insurance producer or employee in violation of M.G.L. c.
			 176D.
(2) A violation of any
			 provision of
			 211 CMR 36.00 by any carrier,
			 insurance producer or employee or authorized agent or representative thereof
			 may be grounds for the imposition of sanctions upon such carrier, insurance
			 producer or employee including without limitation, suspension or revocation of
			 the license of such person or entity.
Code of Massachusetts Regulations › 211 CMR - DIVISION OF INSURANCE › Title 211 CMR 36.00 - The Use Of Aids-related Information For Life And Health Insurance And Informed Consent › Section 36.09 - Severability

Current through Register 1525, July 5, 2024
If any section or portion of a section of
				211 CMR 36.00 or the
				applicability thereof to any person, entity or circumstance is held invalid by
				a court, the remainder of
				211 CMR 36.00 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 37.00 - Infertility Benefits › Section 37.01 - Authority

Current through Register 1525, July 5, 2024
211 CMR
				37.00 is issued under the authority of M.G.L. chs.
				175; 176A; 176B; 176D and 176G.
Code of Massachusetts Regulations › 211 CMR - DIVISION OF INSURANCE › Title 211 CMR 37.00 - Infertility Benefits › Section 37.02 - Purpose

Current through Register 1525, July 5, 2024
The purpose of
				211 CMR
				37.00 is to implement St. 1987, c. 394:
An Act
				Providing a Medical Definition of Infertility,
as amended by St. 2010,
				c. 288, §§ 15, 16 and 17.
Code of Massachusetts Regulations › 211 CMR - DIVISION OF INSURANCE › Title 211 CMR 37.00 - Infertility Benefits › Section 37.03 - Definitions

Current through Register 1525, July 5, 2024
The following words as used in
				211 CMR
				37.00 shall be defined as follows:
Commissioner
: The Commissioner of
				Insurance or his or her designee.
Experimental Infertility Procedure
: A
				procedure not yet recognized as non-experimental as defined in 211 CMR
				37.03.
Infertility
: The condition of an
				individual who is unable to conceive or produce conception during a period of
				one year if the female is age 35 or younger or during a period of six months if
				the female is over the age of 35. For purposes of meeting the criteria of
				infertility in this section, if a person conceives but is unable to carry that
				pregnancy to live birth, the period of time she attempted to conceive prior to
				achieving that pregnancy shall be included in the calculation of the one year
				or six month period, as applicable.
Insured
: A subscriber, member, policy
				holder, certificate holder or his or her covered spouse or other covered
				dependent.
Insurer
: Any company as defined in
				M.G.L. c. 175, § 1 and authorized to write accident and health insurance;
				any hospital service corporation as defined in M.G.L. c. 176A, § 1; any
				medical service corporation as defined in M.G.L. c. 176B, § 1; or any
				health maintenance organization as defined in M.G.L. c. 176G, § 1.
Non-experimental Infertility
				Procedure
: A procedure which is recognized as such by the American
				Society for Reproductive Medicine (ASRM), or the American College of Obstetrics
				and Gynecology (ACOG) or the Society of Assisted Reproductive Technology (SART)
				or another infertility expert recognized as such by the
				Commissioner.
Code of Massachusetts Regulations › 211 CMR - DIVISION OF INSURANCE › Title 211 CMR 37.00 - Infertility Benefits › Section 37.04 - Scope of Coverage

Current through Register 1525, July 5, 2024
Insurers shall provide benefits for required infertility
				procedures, as described in
				211 CMR
				37.05, which are furnished to an insured,
				covered spouse and/or other covered dependent.
Insurers shall not be required to provide benefits for services
				furnished to a spouse or dependent if the spouse or dependent is not otherwise
				covered by the insurer, except as provided in
				211 CMR
				37.05(4).
Code of Massachusetts Regulations › 211 CMR - DIVISION OF INSURANCE › Title 211 CMR 37.00 - Infertility Benefits › Section 37.05 - Required Infertility Benefits

Current through Register 1525, July 5, 2024
Subject to any reasonable limitations as described in
				211 CMR
				37.09, insurers shall provide benefits for
				all non-experimental infertility procedures including, but not limited
				to:
(1) Artificial Insemination (AI)
			 and Intrauterine Insemination (IUI).
(2)
In Vitro
Fertilization
			 and Embryo Transfer (IVF-ET).
(3)
			 Gamete Intrafallopian Transfer (GIFT).
(4) Sperm, egg and/or inseminated egg
			 procurement and processing, and banking of sperm or inseminated eggs, to the
			 extent such costs are not covered by the donor's insurer, if any.
(5) Intracytoplasmic Sperm Injection (ICSI)
			 for the treatment of male factor infertility.
(6) Zygote Intrafallopian Transfer
			 (ZIFT).
(7) Assisted
			 Hatching.
(8) Cryopreservation of
			 eggs.
Code of Massachusetts Regulations › 211 CMR - DIVISION OF INSURANCE › Title 211 CMR 37.00 - Infertility Benefits › Section 37.06 - Prescription Drugs

Current through Register 1525, July 5, 2024
Insurers shall not impose exclusions, limitations or other
				restrictions on coverage for infertility-related drugs that are different from
				those imposed on any other prescription drugs.
Code of Massachusetts Regulations › 211 CMR - DIVISION OF INSURANCE › Title 211 CMR 37.00 - Infertility Benefits › Section 37.07 - Optional Infertility Benefits

Current through Register 1525, July 5, 2024
No insurer shall be required to provide benefits for:
(1) Any experimental infertility procedure,
			 until the procedure becomes recognized as non-experimental;
(2) Surrogacy;
(3) Reversal of Voluntary
			 Sterilization.
Code of Massachusetts Regulations › 211 CMR - DIVISION OF INSURANCE › Title 211 CMR 37.00 - Infertility Benefits › Section 37.08 - Prohibited Limitations on Coverage

Current through Register 1525, July 5, 2024
(1)
			 No insurer shall impose deductibles, copayments, coinsurance, benefit maximums,
			 waiting periods or any other limitations on coverage for required infertility
			 benefits which are different from those imposed upon benefits for services not
			 related to infertility.
(2) No
			 insurer shall impose pre-existing condition exclusions or pre-existing
			 condition waiting periods on coverage for required infertility benefits. No
			 insurer shall use any prior diagnosis of or prior treatment for infertility as
			 a basis for excluding, limiting or otherwise restricting the availability of
			 coverage for required infertility benefits.
(3) No insurer shall impose limitations on
			 coverage based solely on arbitrary factors, including but not limited to number
			 of attempts or dollar amounts.
Code of Massachusetts Regulations › 211 CMR - DIVISION OF INSURANCE › Title 211 CMR 37.00 - Infertility Benefits › Section 37.09 - Permissible Limitations on Coverage

Current through Register 1525, July 5, 2024
Limitations on coverage shall be based on clinical guidelines
				and the insured's medical history. Clinical guidelines shall be maintained in
				written form and shall be available to any insured upon request. Standards or
				guidelines developed by the American Society for Reproductive Medicine, the
				American College of Obstetrics and Gynecology or the Society for Assisted
				Reproductive Technology may serve as a basis for these clinical
				guidelines.
Code of Massachusetts Regulations › 211 CMR - DIVISION OF INSURANCE › Title 211 CMR 37.00 - Infertility Benefits › Section 37.10 - Severability

Current through Register 1525, July 5, 2024
If any section or portion of a section of
				211 CMR
				37.00 or the applicability thereof to any person,
				entity or circumstance is held invalid by a court, the remainder of
				211 CMR
				37.00 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 38.00 - Coordination of Benefits (COB) › Section 38.01 - Purpose and Applicability

Current through Register 1525, July 5, 2024
211 CMR 38.00 establishes an
				order in which Plans pay their claims when a person is covered by more than one
				Plan. Any Plan which contains a Coordination of Benefits provision must comply
				with
				211 CMR 38.00. A Plan that
				does not contain such a provision may not take the benefits of another Plan
				into account when determining its benefits.
Code of Massachusetts Regulations › 211 CMR - DIVISION OF INSURANCE › Title 211 CMR 38.00 - Coordination of Benefits (COB) › Section 38.03 - COB Contract Provisions

Current through Register 1525, July 5, 2024
(1) Any
			 Plan which contains a COB provision must provide information to persons covered
			 under the Plan about its COB provision and the rules used to determine whether
			 it is a Primary Plan or Secondary Plan and to determine and calculate Allowable
			 Expense.
(2) A COB provision may
			 not be used that permits a Plan to reduce its benefits on the basis that:
(a) Another Plan exists and the covered
			 person did not enroll in that Plan;
(b) A person is or could have been covered
			 under another Plan, except with respect to Part B of Medicare; or
(c) A person has elected an option under
			 another Plan providing a lower level of benefits than another option that could
			 have been elected.
(d) No Plan may
			 contain a COB provision that its benefits are "always excess" or "always
			 secondary" except in accordance with the rules permitted by
			 211 CMR 38.00.
(e) No Plan may use a COB provision, or any
			 other provision that allows it to reduce its benefits with respect to any other
			 coverage its insured may have, that does not meet the definition of
			 211 CMR 38.02:
Plan
.
Code of Massachusetts Regulations › 211 CMR - DIVISION OF INSURANCE › Title 211 CMR 38.00 - Coordination of Benefits (COB) › Section 38.04 - Rules for Coordination of Benefits

Current through Register 1525, July 5, 2024
(1)
			 When a person is covered by two or more Plans, 211 CMR 38.04 determines the
			 order of benefit payments:
(a) The Primary
			 Plan must pay or provide its benefits as if the Secondary Plan or Plans did not
			 exist.
(b) If the Primary Plan is a
			 Closed Panel Plan and the Secondary Plan is not a Closed Panel Plan, the
			 Secondary Plan shall pay or provide benefits as if it were the Primary Plan
			 when a covered person uses the services of a health care provider that is not
			 within the Primary Plan's Closed Panel provider network, except for emergency
			 services or authorized referrals that are paid or provided by the Primary
			 Plan.
(c) If the Primary Plan is
			 not a Closed Panel Plan and the Secondary Plan is a Closed Panel Plan, and the
			 covered person uses the services of a health care provider that is not within
			 the Secondary Plan's provider network, then the Secondary Plan is not required
			 to pay or provide benefits, except for emergency services or authorized
			 referrals that are paid or provided by the Primary Plan.
(d) When multiple contracts providing
			 coordinated coverage are treated as a single Plan under
			 211 CMR 38.00, 211 CMR 38.04
			 applies only to the Plan as a whole, and coordination among the component
			 contracts is governed by the terms of the contracts. If more than one carrier
			 pays or provides benefits under the Plan, the carrier designated as primary
			 within the Plan shall be responsible for the Plan's compliance with
			 211 CMR 38.00.
(e) If a person is covered by more than one
			 Secondary Plan, the order of benefit determination rules of
			 211 CMR 38.00 decide the
			 order in which Secondary Plans benefits are determined in relation to each
			 other. Each Secondary Plan shall take into consideration the benefits of the
			 Primary Plan or Plans and the benefits of any other Plan, which, under
			 211 CMR 38.00, has its
			 benefits determined before those of that Secondary Plan.
Code of Massachusetts Regulations › 211 CMR - DIVISION OF INSURANCE › Title 211 CMR 38.00 - Coordination of Benefits (COB) › Section 38.05 - Order of Benefit Determination

Current through Register 1525, July 5, 2024
Each Plan determines its order of benefits using the first of
				211 CMR
				38.05 that applies:
(1) Medical Payments Coverage and PIP
			 Coverage in Motor Vehicle Insurance Policies
(a) If a person who has a Health Benefit Plan
			 and a motor vehicle insurance policy incurs expenses or requires services as a
			 result of an accident with a motor vehicle:
Personal Injury Protection, as defined by M.G.L. c. 90, §
				34A, shall always be primary and pay the first $2,000 of expenses as allowed
				under said statute. PIP shall thereafter be secondary to any such Health
				Benefit Plan(s) and shall coordinate with the Health Benefit Plan(s) pursuant
				to M.G.L. c. 90, §§ 34A and 34M.
(b) Medical Payments Coverage under a motor
			 vehicle insurance policy shall always be secondary to and in excess of any
			 Health Benefit Plan or Personal Injury Protection, as defined under 211 CMR
			 38.00.
Code of Massachusetts Regulations › 211 CMR - DIVISION OF INSURANCE › Title 211 CMR 38.00 - Coordination of Benefits (COB) › Section 38.06 - Procedure to be Followed by Secondary Plan to Calculate Benefits and Pay a Claim

Current through Register 1525, July 5, 2024
In determining the amount to be paid by the Secondary Plan on a
				Claim, should the Plan wish to coordinate benefits, the Secondary Plan shall
				calculate the benefits it would have paid on the Claim in the absence of other
				health care coverage and apply that calculated amount to any Allowable Expense
				under its Plan that is unpaid by the Primary Plan. The Secondary Plan may
				reduce its payments by an amount so that, when combined with the amount paid by
				the Primary Plan, the total benefits paid or provided by all Plans for the
				Claim do not exceed 100% of the total Allowable Expenses for the Claim. In
				addition, the Secondary Plan shall credit toward its Plan deductible the
				amounts it would have credited to its deductible in the absence of other health
				care coverage.
Code of Massachusetts Regulations › 211 CMR - DIVISION OF INSURANCE › Title 211 CMR 38.00 - Coordination of Benefits (COB) › Section 38.07 - Notice to Covered Persons

Current through Register 1525, July 5, 2024
A Plan shall, in its explanation of benefits provided to
				covered persons, include the following language: "If you are covered by more
				than one health benefit plan, you should file all your claims with each
				plan."
Code of Massachusetts Regulations › 211 CMR - DIVISION OF INSURANCE › Title 211 CMR 38.00 - Coordination of Benefits (COB) › Section 38.08 - Miscellaneous Provisions

Current through Register 1525, July 5, 2024
(1) A Secondary
			 Plan that provides benefits in the form of services may recover the reasonable
			 value of the services from the Primary Plan, to the extent that benefits for
			 the services are covered by the Primary Plan and have not already been paid or
			 provided by the Primary Plan. Nothing in 211 CMR 38.08 shall be interpreted to
			 require a Plan to reimburse a covered person in cash for the value of services
			 provided by a Plan which provides benefits in the form of services.
(2)
(a) A
			 Plan with order of benefit determination rules which comply with
			 211 CMR 38.00 ("complying
			 plan") may coordinate its benefits with a Plan which is "excess" or "always
			 secondary" or which uses order of benefit determination rules which are
			 inconsistent with those contained in
			 211 CMR 38.00 ("non-complying
			 plan") on the following basis:
1. If the
			 complying plan is the Primary Plan, it shall pay or provide its benefits
			 first;
2. If the complying plan is
			 the Secondary Plan, it shall, nevertheless, pay or provide its benefits first,
			 but the amount of the benefits payable shall be determined as if the complying
			 plan were the Secondary Plan. In such a situation, such payment shall be the
			 limit of the complying plan's liability; and
3. If the non-complying plan does not provide
			 the information needed by the complying plan to determine its benefits within a
			 reasonable time after it is requested to do so, the complying plan shall assume
			 that the benefits of the non-complying plan are identical to its own, and shall
			 pay its benefits accordingly. If, within two years of payment, the complying
			 plan receives information as to the actual benefits of the non-complying plan,
			 it shall adjust payments accordingly.
Code of Massachusetts Regulations › 211 CMR - DIVISION OF INSURANCE › Title 211 CMR 38.00 - Coordination of Benefits (COB) › Section 38.09 - Effective Date

Current through Register 1525, July 5, 2024
211 CMR 38.00 is applicable
				to any plan contract covering residents of the Commonwealth which is issued or
				renewed within or without the Commonwealth on or after the effective date of
				211 CMR 38.00. A Plan
				contract that provides health care benefits and that was issued before the
				effective date of
				211 CMR 38.00 shall be
				brought into compliance with
				211 CMR 38.00 by:
(1) the later of:
(a) The next anniversary date or renewal date
			 of the contract; or
(b) January 1,
			 2018; or
Code of Massachusetts Regulations › 211 CMR - DIVISION OF INSURANCE › Title 211 CMR 38.00 - Coordination of Benefits (COB) › Section 38.10 - Severability

Current through Register 1525, July 5, 2024
If any provision of
				211 CMR 38.00 or the
				applicability thereof to any person, entity or circumstance is held invalid by
				a court, the remainder of
				211 CMR 38.00 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 39.00 - Annuity Mortality Tables for Use in Determining Reserve Liabilities for Annuities › Section 39.01 - Purpose

Current through Register 1525, July 5, 2024
The purpose of
				211 CMR 39.00 is to recognize
				the following mortality tables for use in determining the minimum standard of
				valuation for annuity and pure endowment contracts: the 1983 Table "a", the
				1983 Group Annuity Mortality (1983 GAM) Table, the Annuity 2000 Mortality
				Table, the 2012 Individual Annuity Reserving (2012 IAR) Table and the 1994
				Group Annuity Reserving (1994 GAR) Table.
Code of Massachusetts Regulations › 211 CMR - DIVISION OF INSURANCE › Title 211 CMR 39.00 - Annuity Mortality Tables for Use in Determining Reserve Liabilities for Annuities › Section 39.02 - Definitions

Current through Register 1525, July 5, 2024
(1) As used in
			 211 CMR 39.00,
1983 Table "a "
means that mortality table developed
			 by the Society of Actuaries Committee to Recommend a New Mortality Basis for
			 Individual Annuity Valuation and adopted as a recognized mortality table for
			 annuities in June 1982 by the National Association of Insurance
			 Commissioners.
(2) As used in
			 211 CMR 39.00
1983 GAM Table
means that mortality table developed by
			 the Society of Actuaries Committee on Annuities and adopted as a recognized
			 mortality table for annuities in December 1983 by the National Association of
			 Insurance Commissioners.
(3) As
			 used in
			 211 CMR 39.00
1994 GAR Table
means that mortality table developed by
			 the Society of Actuaries Group Annuity Valuation Table Task Force and shown on
			 pages 866-867 of Volume XLVII of the Transactions of the Society of Actuaries
			 (1995).
(4) As used in
			 211 CMR 39.00
Annuity 2000 Mortality Table
means that mortality
			 table developed by the Society of Actuaries Committee on Life Insurance
			 Research and shown on page 240 of Volume XLVII of the Transactions of the
			 Society of Actuaries (1995).
(5) As
			 used in
			 211 CMR 39.00
Period Table
means a table of mortality rates
			 applicable to a given calendar year (the Period).
(6) As used in
			 211 CMR 39.00
Generational Mortality Table
means a mortality table
			 containing a set of mortality rates that decrease for a given age from one year
			 to the next based on a combination of a Period table and a projection scale
			 containing rates of mortality improvement.
(7) As used in
			 211 CMR 39.00
2012 IAR Mortality Table
means that Generational
			 mortality table developed by the Society of Actuaries Committee on Life
			 Insurance Research and containing rates, qx2012+n, derived from a combination
			 of the 2012 IAM Period table and Projection Scale G2, using the methodology
			 stated in
			 211 CMR
			 39.04.
(8) As used in
			 211 CMR 39.00
2012 Individual Annuity Mortality Period Life (2012 IAM Period)
			 Table
means the Period table containing loaded mortality rates for
			 calendar year 2012. This table contains rates, qx2012, developed by the Society
			 of Actuaries Committee on Life Insurance Research.
(9) As used in
			 211 CMR 39.00
Projection Scale G2 (Scale G2)
is a table of annual
			 rates, G2x, of mortality improvement by age for projecting future mortality
			 rates beyond calendar year 2012. This table was developed by the Society of
			 Actuaries Committee on Life Insurance Research.