Massachusetts Health Insurance Board Votes For Minimum Coverage Standards

Ruzanna Harutyunyan's picture

The Massachusetts Commonwealth Health Insurance Connector Authority board on Friday voted unanimously to proceed with new minimum standards for health coverage, but added exemptions for individuals, unions or employers who can prove that plans that have not been authorized by the state are comparable to the requirements, the Boston Globe reports. In general, state-approved plans must offer benefits for prescription drugs, preventive and primary care, hospitalization, mental health and substance use services, and emergency services. Those who do not have insurance, or cannot prove that their coverage meets these standards, will face an annual tax penalty. The amount of the penalty is $912 this year, but is expected to increase for 2009, state regulators said.

All insurers licensed in the state will be required to tell members whether their policies meet state standards, but individuals will be responsible for ensuring that their coverage is adequate. Leslie Kirwan, the board's chair and state secretary of Administration and Finance, said, "Our intent is to help, not hurt people," adding, "We will continue to track implementation ... to revisit thorny issues as they arise and to make mid-course corrections where necessary."

Some board members raised concerns that employers might not understand how to determine whether their policies meet the state standards, or how to take action if they do not. Jon Kingsdale, executive director of the board, said there will be presentations throughout the state to address these issues.


The board also voted unanimously to delay until Jan. 1, 2010, implementation of rules mandating benefits for radiation and chemotherapy, maternity and newborn care, and diagnostic imaging and screening tests. The delay is intended to give employers more time to adjust their policies. Mailings will be sent to employers and insurers to help explain the changes, Kingsdale said (Lazar, Boston Globe, 10/18).


Gov. Deval Patrick (D) and state lawmakers "had high hopes for a new law designed to nudge cities and towns toward getting health coverage through the [state] Group Insurance Commission," but even though GIC "has shown it can offer high-quality plans at better prices," the results "haven't justified that optimism," a Globe editorial states. The Globe asks, "So why aren't more enrolling?" adding, "For one thing, the law requires a 70% yes vote from a union-and-retiree committee," meaning that if either the firefighters or the teachers object, the effort dies." According to the Globe, "Further, with teachers only returning to work in late summer, there has been little time to satisfy all their concerns by the Oct. 1 deadline for enrolling."

Localities that have joined GIC "have seen impressive results," the editorial states, concluding that "[w]ith local budgets hurting, the state can no longer afford baby steps" -- it is "time to require that all cities and towns enroll as soon as the GIC can accommodate them" (Boston Globe, 10/20).

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