Connector and Health Plans General

Section 45 (Part 3): Commonwealth Care Eligibility

Sets eligibility standards for the Commonwealth Care health insurance program, which provides subsidized insurance to people with incomes under 300% of the Federal Poverty Level who are not eligible for other publicly-funded programs. Subsidies will be paid based on a sliding scale for eligible plans that are procured by the Connector. Subsidies are not available to workers who are provided coverage by their employers; however, the Connector may waive that restriction.

Section 81: Merged Non-Group and Small Group Insurance Markets

Allows individuals to purchase coverage through the small group insurance market, and provides that the small group insurance law provisions apply to all small business and individual plans issued by an insurance carrier, by the Connector, or through an intermediary.

Section 90: Young Adult Plans Regulations

Establishes insurance plan coverage criteria for Young Adults to be set by Division of Insurance. Only individuals between 19 & 26 who do not have employer-sponsored coverage are eligible for these products. Only insurance carriers with 5,000 or more enrollees may offer Young Adult plans, and the plans must be offered through the Connector.

Section 101 (Part 3): Connector Board Authority

Authorizes the Connector Board to offer insurance products to individuals and small businesses, publish a schedule for premiums at which individuals of varying ages are eligible, and establish a schedule for affordability to be used in enforcing the individual mandate based upon percentage of income eligible to be spent on health care.