Modifies the definition of unfair or deceptive insurance practices by including insurers that arrange for an employee to apply for individual health insurance coverage for the purpose of then excluding that employee from an employer-sponsored health plan, for which the employee is eligible, to reduce costs for other individuals in the employer-sponsored health plan.
Modifies definition of unfair or deceptive insurance acts to include health plan insurance contracts that base reimbursement rates to a health care provider by reference to the price paid, or the average of prices paid, to that provider from any other plan. In addition, an insurer may not refuse to negotiate with a provider based on that provider’s other contracts, type of license, or affiliation with other health plans.
In general, an insurance company must not falsely advertise or misrepresent the nature of an insurance policy or its benefits, discriminate between similarly situated individuals in determining benefits eligibility, engage in unfair claim settlement practices, or fail to maintain a record of grievances.
Expands the existing infertility mandate to require coverage for women over age 35 who are unable to conceive for at least 6 months. Length of time necessary for women under age 35 remains at 1 year. This section applies to plans offered by Blue Cross Blue Shield of Massachusetts.
If a woman conceives but is unable to carry the pregnancy to live birth, the time she attempted to conceive prior to that pregnancy is to be included in the 1 year or 6 month calculation.
Expands the existing infertility mandate to require coverage for women over age 35 who are unable to conceive for at least 6 months. Length of time necessary for women under age 35 remains at 1 year. This section applies to plans offered by Blue Cross Blue Shield of Massachusetts. If a woman conceives but is unable to carry the pregnancy to live birth, the time she attempted to conceive prior to that pregnancy is to be included in the 1 year or 6 month calculation.
Expands the existing infertility insurance benefit mandate to require coverage for women over age 35 who are unable to conceive for at least 6 months. Length of time necessary for women under age 35 remains at 1 year.
If a woman conceives but is unable to carry the pregnancy to live birth, the time she attempted to conceive prior to that pregnancy is to be included in the 1 year or 6 month calculation. This section applies to any general insurance policies that provide pregnancy-related insurance benefits.
Requires that Health Insurance Responsibility Disclosure (HIRD) forms, which employers with 11 or more full time equivalent employees are required to submit to the Division of Health Care Finance and Policy (DHCFP) to verify that they provide section 125 plans and to verify that employees who declined employer sponsored insurance have alternative coverage, be shared with the Department of Revenue, the Commonwealth Health Insurance Connector Authority and the Health Care Access Bureau within the Division of Insurance for enforcement purposes.
Any individually identifiable information will not be public record.
Adds to existing Division of Health Care Finance and Policy (DHCFP) payer data submission requirements by including health status adjusted total medical expenses (TME) by provider group, relative prices paid to every health care provider in the payer’s network by type of provider, and hospital inpatient and outpatient costs. Payers must report each of the three new data categories according to a uniform methodology determined by DHCFP. Hospitals must report to DHCFP inpatient and outpatient costs, including direct and indirect costs, according to a uniform methodology.
Adds new definition of “Relative Prices” within the Division of Health Care Finance and Policy (DHCFP) statute.
This definition relates to provider reimbursement rates. The Division of Insurance (DOI) and DHCFP will determine uniform methodologies for calculating and reporting insurer medical loss ratios, health status adjusted total medical expenses, hospital costs and expenses, and relative prices paid by insurers to providers. DOI and DHCFP will collect and publicly report this information.
Adds new definition of “Health Status Adjusted Total Medical Expense” within the Division of Health Care Finance and Policy (DHCFP) statute. This definition relates to health care payer reporting requirements. The Division of Insurance (DOI) and DHCFP will determine uniform methodologies for calculating and reporting insurer medical loss ratios, health status adjusted total medical expenses, hospital costs and expenses, and relative prices paid by insurers to providers. These agencies will collect and publicly report this information.
Authorizes optometrists to use and prescribe certain therapeutic medications, including the in-office dispensing and sale of therapeutic contact lenses, as long as the medication contained within the lenses is within the provider's designated scope of practice.