Massachusetts Statutes

Section 47A. A contract of insurance or a benefit certificate made, issued or delivered by any society in violation of any provision of this chapter, or any provision of its charter, articles of association, constitution or by-laws, shall nevertheless be valid and binding upon it…

Section 48. A person, officer, member or examining physician of any society who shall knowingly or willfully make any false or fraudulent statement or representation in or with reference to any application for membership, or in order to obtain money from or benefit in any society…

Section 49. (a) Whoever solicits membership in any society not duly authorized to transact business in the commonwealth, or, whoever, for a person other than himself, or as an agent, solicitor, organizer, officer or other representative of any such society or of any local or subo…

Section 49A. A society operating on the lodge system with a representative form of government whose rates are on a basis of mortality not lower than the National Fraternal Congress Table as adopted by the National Fraternal Congress on August 23, 1899, or any society formed under…

Section 5. Societies shall be governed by this chapter, and shall be exempt from all other provisions of the insurance laws of the commonwealth except sections 16, 160A, 160B, 178 to 180, inclusive, and section 185 of chapter 175, not only in governmental relations with the commo…

Section 50. Whoever violates any provision of this chapter for which a specific penalty is not provided shall be punished by a fine of not more than $200.

Section 6. Seven or more persons, residents of the commonwealth, may form a corporation for the purposes set forth in this chapter. The agreement of association shall state that the subscribers thereto associate themselves with the intentions of forming a corporation, the corpora…

Section 7. (a) The first meeting of the associates shall be called by a notice, signed by one or more of the subscribers to the agreement, stating the time, place and purpose of the meeting. At least seven days before the day appointed for the meeting, a copy of the notice shall …

Section 8. (a) The commissioner shall then furnish the incorporators of any such society, if on the lodge plan, with a preliminary license, authorizing it to solicit members for the purpose of completing its organization. (b) A society shall collect from each applicant the amount…

Section 9. The society shall file a certificate of organization, with the certificate endorsed by the commissioner, and if on the lodge plan, also the certificate required by the preceding section, with the state secretary, who, upon the receipt of $5, shall issue a certificate i…

Section 1. As used in this chapter the following words shall, unless the context clearly requires otherwise, have the following meanings:— ''Authority'', the commonwealth health insurance connector authority. ''Board'', the board of the commonwealth health insurance connector, es…

Section 10. The connector seal of approval shall be assigned to health benefit plans or stand-alone vision or stand-alone dental plans, as applicable, that the board determines: (i) meet the requirements of subsection (d) of section 5; (ii) provide good value to consumer; (iii) o…

Section 11. When an eligible individual, eligible child or eligible small group is enrolled in the connector by a producer licensed in the commonwealth, the health plan or stand-alone vision or stand-alone dental plan chosen by each eligible individual, eligible child or eligible…

Section 12. (a) The connector may apply a surcharge to all health benefit plans or stand-alone vision or stand-alone dental plans which shall be used only to pay for administrative and operational expenses of the connector; provided, however, that any such surcharge shall be appl…

Section 13. (a) All expenses incurred in carrying out this chapter shall be payable solely from funds provided under the authority of this chapter and no liability or obligations shall be incurred by the connector hereunder beyond the extent to which monies shall have been provid…

Section 14. The connector shall keep an accurate account of all its activities and of all its receipts and expenditures and shall annually make a report thereof as of the end of its fiscal year to its board, to the governor, to the general court, and to the state auditor, such re…

Section 15. No later than 2 years after the connector begins operation and every year thereafter, the connector shall conduct a study of the connector and the persons enrolled in the connector and shall submit a written report to the governor, the president of the senate, the spe…

Section 15A. There shall be a special commission to investigate and study the role of the connector in providing access to health insurance products. The commission shall examine the connector's utilization of private sector entities, including insurance brokers, and shall invest…

Section 16. The connector may adopt regulations to implement this chapter.

Section 19. (a) Except as required by federal law, the connector shall not provide access to any data, including de-identified data or any other data that would allow the identification of a patient, applicant or provider, in response to an out-of-state or federal inquiry or inve…

Section 2. (a) There shall be a body politic and corporate and a public instrumentality to be known as the commonwealth health insurance connector authority, which shall be an independent public entity not subject to the supervision and control of any other executive office, depa…

Section 3. The purpose of the board of the connector shall be to implement the commonwealth health insurance connector. The goal of the board is to facilitate the purchase of health care insurance products through the connector at an affordable price by eligible individuals and e…

Section 4. (a) The connector shall only offer health benefit plans or stand-alone vision or stand-alone dental plans to eligible individuals, eligible children and eligible small groups. Subconnectors may offer all health benefit plans that the connector may offer. (b) An eligibl…

Section 5. (a) Only health insurance plans and stand-alone vision or stand-alone dental plans that have been authorized by the commissioner and underwritten by a carrier may be offered through the connector. (b) Each health plan or stand-alone vision or stand-alone dental plans o…

Section 6. Eligible small groups seeking to be a participating institution shall, as a condition of participation in the connector, enter in a binding agreement with the connector which, at a minimum, shall stipulate the following:— (a) that the employer agrees that, for the term…

Section 7A. (a) There shall be a small group wellness incentive pilot program to expand the prevalence of employee wellness initiatives by small businesses. The program shall be administered by the board, in consultation with the department of public health. The program shall pro…

Section 8. (a) The connector shall enter into interagency agreements with the department of revenue, the executive office of health and human services, the department of public health, the executive office of labor and workforce development, the registry of motor vehicles, the de…

Section 1. As used in this chapter, the following words shall have the following meanings unless the context clearly requires otherwise: ''Carrier'', an insurer licensed or otherwise authorized to transact accident or health insurance under chapter 175; a nonprofit hospital servi…

Section 2. The commissioner and the group insurance commission shall require that all carriers recognize nurse practitioners as participating providers subject to section 3 and shall include coverage on a nondiscriminatory basis to their insureds for care provided by nurse practi…

Section 3. A participating provider nurse practitioner practicing within the scope of his license including all regulations requiring collaboration with a physician under section 80B of chapter 112, shall be considered qualified within the carrier's definition of primary care pro…

Section 4. Notwithstanding any general or special law to the contrary, a carrier that requires the designation of a primary care provider shall provide its insured with an opportunity to select a participating provider nurse practitioner as a primary care provider or to change it…

Section 5. Notwithstanding any general or special law to the contrary, a carrier shall ensure that all participating provider nurse practitioners are included on any publicly accessible list of participating providers for the carrier.

Section 6. A complaint for noncompliance against a carrier shall be filed with and investigated by the commissioner or the group insurance commission, whichever shall have regulatory authority over the carrier. The commissioner and the group insurance commission shall promulgate …

Section 1. As used in this chapter, the following words shall, unless the context clearly requires otherwise, have the following meanings:— ''Carrier'', (1) an insurer licensed or otherwise authorized to transact accident or health insurance under chapter 175; (2) a nonprofit hos…

Section 2. The commissioner and the group insurance commission shall require that all carriers recognize physician assistants as participating providers subject to section 3 and shall include coverage on a nondiscriminatory basis to their insureds for care provided by physician a…

Section 3. A participating provider physician assistant practicing within the scope of such physician assistant's license, including all regulations requiring collaboration with or supervision by a physician under section 9E of chapter 112, shall be considered qualified within th…

Section 4. Notwithstanding any general or special law to the contrary, a carrier that requires the designation of a primary care provider shall provide its insured with an opportunity to select a participating provider physician assistant as a primary care provider.

Section 5. Notwithstanding any general or special law to the contrary, a carrier shall ensure that all participating provider physician assistants are included on any publicly accessible list of participating providers for the carrier.

Section 6. A complaint for noncompliance against a carrier shall be filed with and investigated by the commissioner or the group insurance commission, whichever shall have regulatory authority over the carrier. The commissioner and the group insurance commission shall promulgate …

Section 1. As used in this chapter the following words shall, unless the context clearly requires otherwise, have the following meanings:— ''Alternative payment contract'', any contract between a provider or provider organization and a health care payer payer which utilizes alter…

Section 2. Except as hereinafter provided, a risk-bearing provider organization shall not be subject to chapters 175, 176A, 176B, 176C, 176E, 176F, 176G and 176J; provided, however, that a risk-bearing provider organization that enters into a contract with employers or individual…

Section 3. (a) Each registered provider organization that enters into or renews an alternative payment contract with a carrier or public health care payer in which the provider organization accepts downside risk shall file an application for a risk certificate with the division; …

Section 4. (a) The commissioner may make an examination of the affairs of a risk-bearing provider organization regarding its alternate payment arrangements with downside risk when the commissioner deems prudent but, not less frequently than once every 3 years. The focus of the ex…

Section 5. (a) If upon examination or at any other time the commissioner determines that the risk-bearing provider organization's existing or proposed alternative payment contracts with downside risk are likely to threaten the financial solvency of the risk-bearing provider organ…

Section 6. (a) For purposes of this section, ''health care provider'' shall mean any physician, hospital or other person or entity furnishing health services that has contracted to provide services according to its agreements with a risk-bearing provider organization. (b) A healt…

Section 7. All information provided by risk-bearing provider organizations to the division under this chapter shall be made available to the center and the commission.