Chapter 32A

Section 1. The purpose of this chapter is to provide a program of group life insurance, group accidental death and dismemberment insurance for certain persons in the service of the commonwealth, and group general or blanket hospital, surgical, medical, dental and other health ins…

Section 10. The commission shall require that, upon retirement of an employee, the policy or policies of insurance as set forth in section six, except the optional group life insurance referred to therein, shall provide that the $10,000 of group life insurance, the $10,000 of gro…

Section 10A. Each employee insured for the minimum amounts of group life and group accidental death and dismemberment insurance provided in section six may, subject to such conditions as the commission shall approve, be insured for amounts of group life insurance and group accide…

Section 10B. The commission shall negotiate with and purchase on such terms as it deems to be in the best interest of the commonwealth, certain political subdivisions that have accepted the provisions of this section, and the elderly governmental retirees and their dependents, fr…

Section 10C. The commission shall negotiate with and purchase on such terms as it deems to be in the best interest of the commonwealth, certain political subdivisions that have been approved by the commission for inclusion under this section, and the active and retired employees …

Section 10D. The commission shall establish a plan of disability insurance on such terms and conditions as it deems to be in the best interest of the commonwealth and its employees. With respect to any disability insurance which is in effect for an employee there shall be withhel…

Section 10E. The health and insurance benefits including, without limitation, policies of group life insurance group accidental death and dismemberment insurance, and the group general or blanket hospital, surgical, medical, dental and other health insurance as provided in this c…

Section 11. Upon the death of an employee or retired employee insured under this chapter, the surviving spouse, or the surviving dependent if there is no surviving spouse, or the surviving dependent if the surviving spouse subsequently dies, may continue the group general or blan…

Section 11A. (a) In the event of the granting of a judgment absolute of divorce or of separate support to which an employee or retiree who has health insurance or coverage under a plan or contract authorized by this chapter is a party, the person who was the spouse of said employ…

Section 12. The commission shall negotiate with and purchase on such terms as it deems to be in the best interests of the commonwealth, the political subdivisions that have accepted the provisions of this section as of April 1, 2018 and teachers retired from such political subdiv…

Section 13. Upon receipt of application from a political subdivision of the commonwealth having accepted the provisions of section eleven E of chapter thirty-two B, the commission shall determine whether the addition of the retired teachers, including dependents and surviving spo…

Section 14. The commission may enter into a contract, hereinafter described, to make available the services of a health care organization to certain eligible active and retired employees and dependents, including the surviving spouse and dependents of such active and retired empl…

Section 15. The commission may negotiate with and purchase on such terms as it deems to be in the best interest of the commonwealth and its active and retired employees and their dependents eligible under this chapter, from one or more insurance carriers authorized to sell health…

Section 16. (a) An employee, in addition to the right of a deferred retiree status, or, conversion of insurance coverages to a non-group policy as provided in this chapter, and upon his involuntary termination of employment due to lack of funds, lack of work, or abolition of the …

Section 17. The commission shall, subject to appropriation, establish a plan of benefits for certain employees which shall, subject to the procedures and conditions established by the commission, reimburse these employees for eligible dental and vision expenses up to but not exce…

Section 17A. The commission shall provide to any active or retired employee of the commonwealth who is insured under the group insurance commission coverage for nonprescription enteral formulas for home use for which a physician has issued a written order and which are medically …

Section 17B. The commission shall provide to any active or retired employee of the commonwealth, who is insured under the group insurance commission, coverage for licensed hospice services to terminally ill patients with a life expectancy of six months or less, as set forth and r…

Section 17C. The commission shall provide to any active or retired employee of the commonwealth who is insured under the group insurance commission coverage for abortion as defined in section 12K of chapter 112, abortion-related care, prenatal care, childbirth and postpartum care…

Section 17D. The commission shall provide to any active or retired employee of the commonwealth who is insured under the group insurance commission coverage for a bone marrow transplant for persons who have been diagnosed with breast cancer that has progressed to metastatic disea…

Section 17E. (a) For the purposes of this section, the following words shall have the following meanings: ''Prosthesis'', an artificial appliance used to replace a lost natural structure; provided, however, that prosthesis shall include, but not be limited to, artificial arms, le…

Section 17F. The commission shall provide to any active or retired employee of the commonwealth who is insured under the group insurance commission coverage for the cost of a newborn hearing screening test to be performed before the newborn infant is discharged from the hospital …

Section 17G. The commission shall provide to an active or retired employee of the commonwealth who is insured under the group insurance commission coverage for the following items if such items are within a category of benefits or services for which coverage is otherwise afforded…

Section 17H. The commission shall provide to any active or retired employee of the commonwealth who is insured under the group insurance commission coverage for the cost of human leukocyte antigen testing or histocompatibility locus antigen testing that is necessary to establish …

Section 17I. (a) The commission shall provide coverage for prosthetic devices and repairs to any active or retired employee of the commonwealth who is insured under the group insurance commission under the same terms and conditions that apply to other durable medical equipment co…

Section 17J. The commission shall provide to any active or retired employee of the commonwealth who is insured under the group insurance commission coverage for the cost of treating cleft lip and cleft palate for children under the age of 18 covered by that employee's health plan…

Section 17K. Any coverage offered by the commission to an active or retired employee of the commonwealth insured under the group insurance commission that provides coverage for cancer chemotherapy treatment shall provide coverage for prescribed, orally administered anticancer med…

Section 17L. Any coverage offered by the commission to an active or retired employee of the commonwealth insured under the group insurance commission shall provide coverage for abuse deterrent opioid drug products listed on the formulary, compiled pursuant to subsection (b) of se…

Section 17M. For the purposes of this section the term ''substance abuse treatment'' shall include: early intervention services for substance use disorder treatment; a substance use disorder evaluation as defined in section 511/2 of chapter 111; outpatient services including medi…

Section 17N. For the purposes of this section the following terms shall have the following meanings, unless the context clearly requires otherwise:— ''Acute treatment services'', 24–hour medically supervised addiction treatment for adults or adolescents provided in a medically ma…

Section 17O. Any coverage offered by the commission to an active or retired employee of the commonwealth insured under the group insurance commission shall provide coverage for medical or drug treatments to correct or repair disturbances of body composition caused by HIV associat…

Section 17P. The commission shall provide, to an active or retired employee of the commonwealth who is insured under the group insurance commission, for any covered drug that is a narcotic substance contained in schedule II pursuant to chapter 94C and subject to cost sharing, tha…

Section 17Q. (a) The commission shall develop a plan to provide active or retired employees insured under the group insurance commission adequate coverage and access to a broad spectrum of pain management services, including, but not limited to, non-medication, nonsurgical treatm…

Section 17R. The commission shall provide to any active or retired employee of the commonwealth who is insured under the group insurance commission coverage for treatment of pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections and pediatric acu…

Section 17S. (a) For the purposes of this section, the following terms shall have the following meanings unless the context clearly requires otherwise:- ''Community-based acute treatment'', 24–hour clinically managed mental health diversionary or step-down services for children a…

Section 17T. (a) For the purposes of this section, the following words shall have the following meanings unless the context clearly requires otherwise: ''Directly or indirectly cause impairment of fertility'', to cause circumstances where a disease or the necessary treatment for …

Section 17U. The commission shall provide to any active or retired employee of the commonwealth who is insured under the group insurance commission coverage for postpartum depression and major depressive disorder screenings conducted pursuant to section 247 of chapter 111.

Section 17V. (a) The commission shall provide to any active or retired employee of the commonwealth who is insured under the group insurance commission coverage for the provision of medically necessary pasteurized donor human milk and donor human milk-derived products; provided, …

Section 17W. The commission shall provide to any active or retired employee of the commonwealth who is insured under the group insurance commission coverage for universal postpartum home visiting services in accordance with operational standards set by the department of public he…

Section 17X. (a) Coverage offered by the commission to an active or retired employee of the commonwealth insured under the group insurance commission shall provide coverage for prescribed, ordered or dispensed opioid antagonists, as defined in section 19B of chapter 94C and used …

Section 17Y. The commission shall provide to any active or retired employee of the commonwealth who is insured under the group insurance commission coverage for the provision of services by a recovery coach licensed or otherwise authorized to practice pursuant to chapter 111J, re…

Section 17Z. (a) As used in this section, the following words shall have the following meanings unless the context clearly requires otherwise: ''Brand name drug'', a drug that is: (i) produced or distributed pursuant to an original new drug application approved under 21 U.S.C. 35…

Section 18. Notwithstanding any other provision of this chapter, all retirees, their spouses and dependents insured or eligible to be insured under sections five, ten B and twelve, if enrolled in medicare part A at no cost to the retiree, spouse or dependents, or eligible for cov…

Section 19. Effective January 1 and July 1 of each year, the commission may pay to any active or retired employee of the commonwealth who has been continuously insured by the commonwealth for the prior 6 months pursuant to the provisions of this chapter for hospital, surgical, me…

Section 2. The following words and phrases as used in this chapter shall have the following meanings:-- (a) "Commission'', the group insurance commission. [ Subsection (b) effective until July 1, 2025. For text effective July 1, 2025, see below.] (b) "Employee'', any person in th…

Section 20. No physician or other provider of services, who treats or provides services to an individual covered by hospital, surgical, medical or catastrophic illness coverage offered by the commission under section four, four A, ten B, twelve or fifteen, shall charge to or coll…

Section 21. The commission is hereby authorized and directed to establish and implement a vendor quality improvement program for purposes including, but not limited to: the evaluation and improvement of all health care services as applied to those contracts and the promotion of c…

Section 22. (a) The commission shall provide to any active or retired employee of the commonwealth who is insured under the group insurance commission coverage on a nondiscriminatory basis for the diagnosis and treatment of the following biologically-based mental disorders, as de…

Section 22A. (a) For the purposes of this section, ''psychiatric collaborative care model'' shall mean the evidence-based, integrated behavioral health service delivery method in which a primary care team consisting of a primary care provider and a care manager provides structure…

Section 22B. (a) The commission shall implement and enforce the mental health parity provisions of the federal Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008, 42 U.S.C. 300gg–26, as amended, federal guidance or regulations issued under the …

Section 23. The commission shall provide to any active or retired employee of the commonwealth who is insured under the commission coverage for expenses incurred in the medically necessary diagnosis and treatment of speech, hearing and language disorders by individuals licensed a…