Individual Massachusetts Health Insurance Regulations

In Massachusetts, individual medical insurance policies cannot be medically underwritten. This means that applicants cannot have coverage refused because of their current health status or past health history. Medical insurance companies in Massachusetts must offer standardized health insurance plans to every applicant if that company sells individual health insurance policies. The standardized plan options are: Medical Plan, Preferred Provider Plan and Managed Care Plan. Each option must make comprehensive coverage available. This includes physician and hospital care, preventive care, immunizations, maternity care and prescription drug coverage. Look back periods can go back 6 months and exclusionary periods for pre-existing conditions are also allowed. Massachusetts also requires proof of prior coverage as long as there is no more than a 63 day gap in coverage. Age, family size and location are considered when determining premium rates under a modified community rating system.

Massachusetts Small Group Health Insurance Regulations

When applying for small business Massachusetts health insurance, any company with 1-50 employees is considered a small group in Massachusetts. Small group health insurance in Massachusetts is given on a guarantee issue basis which means that a group cannot have their coverage refused because of the group's health status. In order to join the employer's group plan, the employer may require that each employee go through a waiting period. Any applicants that cannot show proof of past health coverage may have a 6 month pre-existing condition period of exclusion. This is determined by the medical insurance company. Rates for group medical insurance in Massachusetts are community based and rates can vary with the group's age, size, location, industry, family make-up and the percentage of group participation. In addition, groups that take part in wellness programs can receive discounted rates. In the state, self-employed groups of one can also receive low cost group health insurance in Massachusetts.

Massachusetts COBRA and Continuation Coverage

In Massachusetts, every resident in the state is eligible for medical insurance so continuation and COBRA laws are not as important as the laws in other states. However, people can still remain on their affordable group health insurance plan instead of switching to an individual plan, so COBRA laws are still in place. State mini-COBRA laws apply to groups of less than 20, and larger companies must follow federal COBRA laws. If an employee has a qualifying event, then they van receive continuation of coverage from COBRA under their group health plan. This employee can remain on their previous employer's low cost group health insurance plan and continue to receive coverage for a certain length of time. Depending upon the qualifying event, Massachusetts law says the maximum time spans are 18, 29 and 36 months. COBRA coverage premiums cannot be greater than 102% of the cost of the group health plan, and the premiums are paid by the employee. For anyone that has used up their COBRA coverage, there are conversion plans available. Also, the employee can choose a conversion plan over the group health plan.

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