Massachusetts Refines Health Care Coverage Rules

Massachusetts regulators plan to clarify final rules soon on the design requirements of health plans state residents must be enrolled in to avoid financial penalties.

On January 1, 2009, under the state’s landmark health care reform law, most state residents will have to be covered in plans that meet minimum “creditable coverage criteria.”

Under rules finalized last June by the Commonwealth Health Insurance Connector Authority—the state agency in charge in implementing key portions of the 2006 reform law—plans considered offering minimum coverage can’t, among other things, have annual deductibles greater than $2,000 for individual coverage or $4,000 for family coverage.

Additionally, in order for the enrollees to have creditable coverage, a plan cannot impose an overall annual benefit limit or a per illness annual maximum benefit for covered core services. The bulletin will provide more clarification of what are considered covered core services, a spokesman for the Connector Authority said.

The bulletin itself will be issued in about a week, said Jon Kingsdale, executive director of the Connector Authority, who spoke Monday at a briefing in Washington sponsored by the Alliance for Health Reform and the Kaiser Family Foundation.

Since enactment of the Massachusetts law, about 340,000 previously uninsured state residents have obtained coverage, with the largest number of the newly insured enrolled in a program whose premiums are heavily subsidized by the state.