Tufts Health Plan Update, News for the Marketplace
07/30/2008
Minimum Creditable Coverage for Fully-Insured Clients As part of the Massachusetts Health Care Reform Act (Chapter 58 of the Acts of 2006) mandate, all residents over the age of 18 must have health insurance as of January 1, 2009, which meets the state’s criteria for Minimum Creditable Coverage (MCC). MCC defines the basic requirements for fully-insured health insurance plans for Massachusetts residents. There are a number of reasons why a plan would not meet MCC criteria. MCC Requirements A plan does not meet MCC requirements if any of the following applies: - The in-network deductible is more than $2,000 for an individual and/or $4,000 for a family.
- A broad range of medical benefits, as defined by the Connector, are not covered.
- Prescription drugs are not covered
- The deductible for prescription drug coverage is more than $250 for an individual and/or $500 for a family.
- The health plan includes deductibles or coinsurance for in-network core services, but does not include an out-of-pocket maximum.
- The health plan includes deductibles or coinsurance for in-network core services, but the out-of-pocket maximum is more than $5,000 for an individual and/or $10,000 for a family.
- The health plan includes deductibles or coinsurance for in-network core services, but the out-of-pocket maximum does not include one or more of the following for in-network services: copayments over $100, coinsurance, or deductibles.
- The health plan imposes an overall annual maximum benefit or a per illness annual maximum benefit for covered core services.
- A fee schedule is imposed on indemnity benefits for in-network covered services.
- The deductible for in-network benefits does not exclude the required minimum of three preventive care visits for individual coverage and six preventive care visits for all other coverage types (i.e., two-person, individual plus child, family).
Employer Obligations Employers with more than 11 full-time equivalent employees must contribute toward health insurance coverage and health care costs in one of two ways: - Prospectively, by arranging for or contributing to the purchase of health insurance for their employees.
- Retrospectively, through fines and penalties assessed under Chapter 58. If your company’s health insurance plan does not meet MCC requirements, your employees who are members of your plan may be subject to tax penalties starting January 1, 2009.
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