Code of Massachusetts Regulations › 956 CMR - COMMONWEALTH HEALTH INSURANCE CONNECTOR AUTHORITY › Title 956 CMR 8.00 - Student Health Insurance Program › Section 8.04 - Student Health Insurance Program Requirements

Current through Register 1525, July 5, 2024
(1)
Required
			 Benefits
. A School's Student Health Insurance Program must provide
			 benefits that are substantially equal to the Essential Health Benefits
			 Benchmark Plan, in a manner consistent with the requirements and procedures of
			 45 CFR §
									156.115.
(2)
Other
			 Requirements
. A School's Student Health Insurance Program:
(a) may not exclude or limit coverage, except
			 as otherwise permitted by 956 CMR 8.04(3), of any Student who is away from
			 campus for any reason;
(b) must
			 include services delivered in accordance with the healing practices of
			 Christian Science;
(c) for all plan
			 years beginning January 1, 2014, or later must not impose an annual or lifetime
			 limit on the dollar amount of required benefits for any covered individual, as
			 established in 956 CMR 8.04(1);
(d)
			 must offer a prorated premium refund to any Student who paid to enroll in a
			 Student Health Insurance Program for an entire School Year but who is not a
			 Student at the beginning of a term during that School Year, provided the School
			 is not required to offer such a refund to a Student who disenrolls during a
			 term; offer a prorated premium refund to any Student who paid to enroll in a
			 Student Health Insurance Program for an entire School Year but who becomes
			 eligible for a subsidized Health Benefit Plan through the Connector or becomes
			 eligible for MassHealth, and who uses enrollment in such coverage to waive the
			 School's Student Health Insurance Program, provided the refund shall be
			 prorated by term and provided the Student becomes eligible prior to the
			 beginning of the term for which the refund is requested; offer Students the
			 opportunity to enroll in partial year coverage, which may be prorated by term;
			 and specify in writing its policy regarding premium refunds and partial year
			 Student enrollment;
(e) must comply
			 with the standards and requirements set out in
			 45 CFR
			 §
										147.136 with regard to internal claims
			 and appeals. Carriers must provide Students with notification of the right of
			 appeal to the Office of Patient Protection;
(f) must designate at least one member of the
			 School's staff as the Student Health Insurance Program contact person to help
			 Students with any Student Health Insurance Program issues that may
			 arise;
(g) must not consider a
			 Student a late enrollee if a request for enrollment is made within 60 days
			 after termination of coverage under another health insurance plan, including
			 MassHealth and prorate premiums for such Student based on the month of
			 enrollment in the Student Health Program;
(h) must comply with the standards and
			 requirements set out in
			 45 CFR §
										147.108 with regard to preexisting condition
			 exclusions;
(i) must comply with
			 the standards and requirements set out in
			 45 CFR §§
										147.104 and
			 147.106
			 with regard to availability and renewability of coverage, except for those
			 exemptions applicable to Student health insurance in
			 45 CFR §
										147.145(b);
(j) must comply with the standards and
			 requirements set out in
			 45
			 CFR §
										147.110 with regard to
			 discriminating against beneficiaries;
(k) must comply with the standards and
			 requirements set out in
			 45 CFR §
										147.128 with regard to rescission of
			 coverage;
(l) must comply with the
			 standards and requirements set out in
			 45 CFR §
										147.130 with regard to cost-sharing for
			 preventive services; except that Student administrative health fees are
			 considered in the same manner as in
			 45 CFR §
										147.145(c);
(m) must comply with the standards and
			 requirements set out in
			 45 CFR §
										147.138(a) with regard to
			 choice of healthcare professionals;
(n) must comply with the standards and
			 requirements set out in
			 45 CFR §
										147.138(b) with regard to
			 coverage of Emergency Services, including services received out of
			 network;
(o) must comply with the
			 standards and requirements set out in
			 45 CFR
			 148.170 with regard to benefits for mothers
			 and newborns; and
(p) must comply
			 with the standards and requirements set out in
			 45 CFR
			 148.180 with regard to discrimination based
			 on genetic information.