Massachusetts Statutes

Section 4RR. Any individual or group health maintenance contract that is issued or renewed within or without the commonwealth shall provide coverage for universal postpartum home visiting services, in accordance with operational standards set by the department of public health pu…

Section 4S. (a) Individual and group health maintenance contracts shall provide coverage for prosthetic devices and repairs. If prosthetic devices are covered as a durable medical equipment benefit, coverage shall be provided under the same terms and conditions that apply to othe…

Section 4SS. (a) As used in this section, the following words shall, unless the context clearly requires otherwise, have the following meanings:— ''Cost sharing'', a deductible, coinsurance, copayment and any maximum limitation on the application of such a deductible, coinsurance…

Section 4T. A health maintenance contract, except certificates which provide stand-alone dental services, supplemental coverage to Medicare or other governmental programs, shall provide, as benefits to all individuals or to group members having a principal place of employment wit…

Section 4TT. (a) An individual or group health maintenance contract that is issued or renewed within or without the commonwealth shall provide coverage for prescribed, ordered or dispensed opioid antagonists, as defined in section 19B of chapter 94C and used in the reversal of ov…

Section 4U. No individual or group health maintenance contract shall restrict or discontinue coverage for medically necessary hypodermic syringes or needles, notwithstanding section 27 of chapter 94C. The term ''medical necessity'' shall be construed in accordance with the guidel…

Section 4UU. An individual or group health maintenance contract that is issued or renewed within or without the commonwealth shall provide coverage for the provision of services by a recovery coach licensed or otherwise authorized to practice under chapter 111J, regardless of the…

Section 4V. (a) As used in this section the following words shall, unless the context clearly requires otherwise, have the following meanings:— ''Actuary'', a person who is a member of American Academy of Actuaries and meets the academy's professional qualification standards for …

Section 4VV. (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 4W. A health maintenance contract issued or renewed within or without the commonwealth that covers a child under the age of 18 shall provide coverage for the cost of treating cleft lip and cleft palate for the child. The coverage shall include benefits for medical, dental…

Section 4X. Any individual or group health maintenance contract that provides coverage for cancer chemotherapy treatment shall provide coverage for prescribed, orally administered anticancer medications used to kill or slow the growth of cancerous cells on a basis not less favora…

Section 4Y. An individual or group health maintenance contract that is issued or renewed shall provide coverage for abuse deterrent opioid drug products listed on the formulary, compiled pursuant to subsection (b) of section 13 of chapter 17, on a basis not less favorable than no…

Section 4Z. 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 5. (a) As used in this section, the following words shall have the following meanings:- ''Attending physician'', the emergency physician or consultant physician who actively treats the emergency medical condition of a member at an emergency facility. ''Emergency medical c…

Section 5A. (a) In the event of the granting of a judgment absolute of divorce or of separate support to which a member of a group health maintenance contract is a party, the person who was the spouse of said member prior to the issuance of such judgment shall be and remain eligi…

Section 6. A health maintenance organization may enter into contractual arrangements with any other person or company for the provision, to the health maintenance organization, of health services, insurance, reinsurance and administrative, marketing, underwriting or other service…

Section 6A. A health maintenance organization may only enter into a group health maintenance contract with an employer if the group health maintenance contract is offered by that employer to all full-time employees who live in the commonwealth; provided, however, the employer sha…

Section 6B. (a) For the purposes of this section, the following words shall have the following meanings unless the context clearly requires otherwise: ''Behavioral health services'', as defined in section 1 of chapter 175, or ''services''. ''Provider'', (i) a mental health clinic…

Section 8. Public dissemination of any promotional material, evidence of coverage, health maintenance contract or any other statement with respect to a health maintenance organization, which is untrue, deceptive or misleading, shall constitute an unfair and deceptive practice und…

Section 9. The provisions of sections 1 to 14K, inclusive, and sections 48 to 68, inclusive, of chapter ninety-three, and chapter ninety-three A shall be applicable to the ownership, organization, operation and health care services provided by a health maintenance organization as…

Section 1. In this chapter the following words shall have the following meanings:— ''Attorney'', an attorney at law who is a member of the bar of the commonwealth or any other state. ''Commissioner'', the commissioner of insurance. ''Covered dependents'', dependents of an insured…

Section 10. The rates to be charged by a sponsor under a membership legal services plan approved under this chapter shall be filed and determined in accordance with the provisions of sections one through five and six through twenty of chapter one hundred and seventy-five A.

Section 11. The commissioner may, upon not less than fifteen days' written notice to all interested parties, hold a public hearing upon an insured legal services plan or a membership legal services plan previously approved by him under section five or section nine of this chapter…

Section 12. Any insurer or sponsor or other interested party aggrieved by any order or decision of the commissioner made without a hearing, or the advisory committee on prepaid legal services may, within fifteen days after written notice of the order or decision, make written req…

Section 13. The commissioner, or any deputy examiner or any other person designated by the commissioner, shall, at least once in three years, and at other times the commissioner deems prudent, visit any sponsor, other than an employer or employee organization subject to the Emplo…

Section 13A. Notwithstanding any general or special law to the contrary, chapter 176V shall apply to legal services plans governed by this chapter.

Section 13B. Notwithstanding any general or special law to the contrary, chapter 176W shall apply to legal services plans governed by this chapter.

Section 14. Any dispute or controversy arising between an insurer or sponsor and any attorney, insured, or member, or any person whose insurance certificate contract or membership certificate has been canceled or to whom an insurer or sponsor has refused to issue an insurance cer…

Section 15. Upon application to the superior court by the commissioner, injunctive relief may be granted if any sponsor of an insured legal services plan or a membership legal services plan has failed to comply with the provisions of this chapter; is operating fraudulently; is op…

Section 16. It shall be unlawful for any person, group of persons, or entity except an insurer or sponsor of an insured legal services plan or a membership legal services plan, to establish, underwrite, operate or offer to sell a legal services plan, except in conformity with the…

Section 17. The commissioner may, after public hearing, promulgate appropriate rules and regulations for the execution of his duties under this chapter. The rules and regulations may include such provisions as the commissioner deems necessary to assure that legal services plans o…

Section 19. The provisions of this chapter may be enforced by a complaint brought in the superior court by the commissioner or the advisory committee on prepaid legal services.

Section 2. Any sponsor may establish and operate an insured legal services plan underwritten in whole or in part by an insurer subject to the provisions of this chapter. An insured legal services plan may be either an indemnity plan or a service plan, or a combination of both. Un…

Section 3. Insurance corporations may be insurers of insured legal services plans, and such companies shall be subject to the insurance laws of the commonwealth except insofar as any provision of the insurance laws may be in conflict with applicable provisions of this chapter. An…

Section 4. An insurance certificate shall be issued to each insured under an insured legal services plan. No insurance certificate shall be issued unless it contains the following provisions:— (a) A statement of covered legal services and the basis for payment for such legal serv…

Section 5. No insurer shall issue a group insurance policy providing benefits for legal services or an insurance certificate which is a contract, or any amendment to such group policy provisions or insurance certificate previously approved and issued without prior approval of the…

Section 6. The rates to be charged by an insurer for an insurance certificate contract under an insured legal services plan approved under the provisions of this chapter shall be filed and determined in accordance with the provisions of sections one to five, inclusive, and six to…

Section 7. Any corporation formed under the provisions of chapter one hundred and eighty, any corporation formed under general or special law for any of the purposes set forth in section four of chapter one hundred and eighty, or any labor organization is authorized to establish …

Section 8. A membership certificate shall be issued by a sponsor to each participating member under a membership legal services plan. No membership certificate shall be issued unless it contains the following provisions:— (a) A statement of covered legal services under the certif…

Section 9. No sponsor shall issue a membership certificate or any amendment to a membership certificate previously approved and issued without prior approval of the commissioner, and prior to such approval the sponsor shall file a copy of the membership legal services plan and me…

Section 1. The following words as used in this chapter shall have the meanings given to them in this section unless the context clearly requires otherwise: ''Commissioner'', the commissioner of insurance. ''Covered person'', any policy holder or other person on whose behalf the o…

Section 10. Any organization which has entered into preferred provider arrangements prior to the effective date of this chapter shall file an application within ninety days of the effective date of this chapter, and may continue to operate until such time as its application may b…

Section 11. (a) Every organization other than a workers' compensation insurer, operating a preferred provider arrangement shall annually pay an assessment equal to two and twenty-eight hundredths per cent of the gross premiums received during the preceding calendar year for cover…

Section 12. An organization entering into a preferred provider contract that covers a child under the age of 18 shall provide coverage for the cost of treating cleft lip and cleft palate for the child. The coverage shall include benefits for medical, dental, oral and facial surge…

Section 13. (a) For the purposes of this section, the following words shall, unless the context clearly requires otherwise, have the following meanings: ''Behavioral health services'', care and services for the evaluation, diagnosis, treatment or management of patients with menta…