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Your Rights under Massachusetts Health Insurance Law
(Copyright 2005 All Rights Reserved) Individual Health Insurance: In Massachusetts, your ability to buy individual health insurance does not depend on your health status. Companies that sell individual health insurance in Massachusetts are not permitted to turn you down because of your health status and other factors. All plans that provide benefits for any minor must cover newborns, newborns of dependents and newly adopted children from moment of birth and thereafter. If you are HIPAA eligible, (Health Insurance Portability and Accountability), you are guaranteed the same right to purchase individual health insurance as other individuals. Massachusetts requires that individual insurers offer standardized policies to all consumers. Individual health insurers may also offer a plan that has the same benefits as the standard plan but has higher co-payments, deductibles and excludes prescription drug coverage. If you buy health insurance, there are limits on pre-existing condition exclusion periods that can be imposed. In Massachusetts, if you buy individual health insurance you may be subject to a waiting period for up to six months. Individual health insurers are not allowed to impose elimination riders, which permanently exclude coverage for a health condition, body part, or body system. Premiums for individual health insurance in Massachusetts cannot vary due to your gender, health status, or occupation. If your employer has 2-19 employees and offers small group health benefits, you may also be eligible for up to 36 months of continuation coverage under a Massachusetts law that is similar to COBRA (state continuation coverage). In Massachusetts, you can buy individual insurance regardless of whether you are eligible for or used up your federal or state continuation coverage. MassHealth is a program that provides health coverage to some low-income Massachusetts residents. It covers families with children and pregnant women, medically needy individuals, the elderly, and people with disabilities if state and federal guidelines are met. Children’s Medical Security Plan (CMSP) is a state-designed program that provides health coverage to low-income children under the age of 19 who are not eligible for MassHealth and who have limited or no health insurance. Women who are diagnosed with breast or cervical cancer through the Massachusetts Women’s Health Network can apply for full health coverage through MassHealth, which will cover the costs of treatment. For more information, please visit the Massachusetts Division of Insurance at http://www.mass.gov/doi/ Group Health Insurance: If your fully insured employer coverage covers minor children, it must cover newborns, newborns of dependents, and newly adopted children from moment of birth and thereafter. Under Massachusetts law, disabled adult children can remain on their parents’ group health plan after reaching the age at which dependent coverage is usually terminated if they meet certain requirements. Group health plans cannot apply a pre-existing condition exclusion period for pregnancy, newborns or newly adopted children, children placed for adoption, or genetic information. Massachusetts law also allows your insurer to impose a waiting period regardless of whether you have a pre-existing condition.
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