CONTRIBUTORY GROUP GENERAL OR BLANKET INSURANCE FOR PERSONS IN THE SERVICE OF THE COMMONWEALTH

M.G.L. pt. Part I, tit. Title IV, ch. c. 32A

in effect

M.G.L. c. 32A, § 1 Purpose of chapter

c. 32A, § 1. Purpose of chapter Section 1. The purpose of this chapter is to provide a program of group life insurance, group accidental death and dismemberment insurance for certain persons in the service of the commonwealth, and group general or blanket hospital, surgical, medical, dental and other health insurance for such persons and their dependents.

M.G.L. c. 32A, § 2 Definitions

c. 32A, § 2. Definitions Section 2. The following words and phrases as used in this chapter shall have the following meanings:-- (a) "Commission'', the group insurance commission. [ Subsection (b) effective until July 1, 2025. For text effective July 1, 2025, see below.] (b) "Employee'', any person in the service of the commonwealth, which shall include a person employed by the National Guard as a technician, and who is not at the same time an employee of the United States, and a person who is an employee of a mosquito control project, the Massachusetts Parking Authority, the metropolitan area planning council, the Montachusett regional planning commission, the central Massachusetts regional planning district commission, the Massachusetts State College Building Authority, Massachusetts School Building Authority, the commonwealth health insurance connector authority, the Massachusetts gaming commission, the Massachusetts cannabis control commission, the Massachusetts Life Sciences Center, the Massachusetts Department of Transportation, the Massachusetts Bay Transportation Authority, Worcester county, the county cooperative extension service of Suffolk county, a local housing authority or a redevelopment authority, whether such person be employed, appointed or elected by popular vote, provided the duties of such person require that his time be devoted to the service of the commonwealth during the regular work week of permanent employees, except that persons elected by popular vote, other than those serving as members of mosquito control projects, local housing and redevelopment authorities, will be considered employees during the entire term for which they are elected regardless of the hours devoted to the service of the commonwealth. By way of illustration but not limitation, a person appointed or elected by popular vote shall include employees of the general court, state officials, constitutional officers and members of the general court, but shall in no event be construed to include members of the judiciary paid in whole or in part from other than state funds, seasonal employees or emergency employees. A determination by the commission that a person is eligible for participation in the plan of insurance shall be final and shall be binding on all parties. A person serving on a temporary or provisional basis in a position which is subject to the provisions of chapter thirty-one, notwithstanding the provisions of said chapter, and only for purposes of continuation of insurance coverages granted herein, may be granted a leave of absence by the appointing authority for reasons of illness of such person provided that the person agrees in writing to return to an active working status at the conclusion of such leave of absence in the same or similar position. Any such illness shall be evidenced by a certificate as prescribed by the commission of a registered physician approved by the commission. The appointing authority may extend such leave of absence from month to month subject to concurrence by the commission as to the continuation of the person's insurance coverages. Such a leave of absence in the case of employment subject to said chapter thirty-one shall not be deemed to confer on the person any civil service rights which the person did not hold when said leave of absence was granted; and no person whose name is on an eligible civil service list for said position shall lose any rights to appointment to said position. A person employed by a regional council of government established pursuant to section 20 of chapter 34B or a regional planning district or commission established pursuant to chapter 40B, a non-unionized education collaborative as defined by section 4E of chapter 40 or a commonwealth charter school as defined by section 89 of chapter 71 shall be an employee under chapter 32A and subject to the terms and conditions of said chapter 32A including, but not limited to, premium contribution ratios, in the event that the governing body of the regional council of government or the regional planning district or commission votes to accept that status and notifies the commission of the vote. [ Subsection (b) as amended by 2025, 9, Sec. 28 effective July 1, 2025. See 2025, 9, Sec. 138. For text effective until July 1, 2025, see above.] (b) "Employee'', any person in the service of the commonwealth, which shall include a person employed by the National Guard as a technician, and who is not at the same time an employee of the United States, and a person who is an employee of a mosquito control project, the Massachusetts Parking Authority, the metropolitan area planning council, the Montachusett regional planning commission, the central Massachusetts regional planning district commission, the Massachusetts State College Building Authority, Massachusetts School Building Authority, the commonwealth health insurance connector authority, the Massachusetts gaming commission, the Massachusetts cannabis control commission, the Massachusetts Life Sciences Center, the Massachusetts Department of Transportation, the Massachusetts Bay Transportation Authority, the advisory board to the Massachusetts Bay Transportation Authority as established in section 7A of chapter 161A, Worcester county, the county cooperative extension service of Suffolk county, a local housing authority or a redevelopment authority, whether such person be employed, appointed or elected by popular vote, provided the duties of such person require that his time be devoted to the service of the commonwealth during the regular work week of permanent employees, except that persons elected by popular vote, other than those serving as members of mosquito control projects, local housing and redevelopment authorities, will be considered employees during the entire term for which they are elected regardless of the hours devoted to the service of the commonwealth. By way of illustration but not limitation, a person appointed or elected by popular vote shall include employees of the general court, state officials, constitutional officers and members of the general court, but shall in no event be construed to include members of the judiciary paid in whole or in part from other than state funds, seasonal employees or emergency employees. A determination by the commission that a person is eligible for participation in the plan of insurance shall be final and shall be binding on all parties. A person serving on a temporary or provisional basis in a position which is subject to the provisions of chapter thirty-one, notwithstanding the provisions of said chapter, and only for purposes of continuation of insurance coverages granted herein, may be granted a leave of absence by the appointing authority for reasons of illness of such person provided that the person agrees in writing to return to an active working status at the conclusion of such leave of absence in the same or similar position. Any such illness shall be evidenced by a certificate as prescribed by the commission of a registered physician approved by the commission. The appointing authority may extend such leave of absence from month to month subject to concurrence by the commission as to the continuation of the person's insurance coverages. Such a leave of absence in the case of employment subject to said chapter thirty-one shall not be deemed to confer on the person any civil service rights which the person did not hold when said leave of absence was granted; and no person whose name is on an eligible civil service list for said position shall lose any rights to appointment to said position. A person employed by a regional council of government established pursuant to section 20 of chapter 34B or a regional planning district or commission established pursuant to chapter 40B, a non-unionized education collaborative as defined by section 4E of chapter 40 or a commonwealth charter school as defined by section 89 of chapter 71 shall be an employee under chapter 32A and subject to the terms and conditions of said chapter 32A including, but not limited to, premium contribution ratios, in the event that the governing body of the regional council of government or the regional planning district or commission votes to accept that status and notifies the commission of the vote. (c) "Employer'', the commonwealth of Massachusetts. (d) "Dependents'', an employee's spouse, his unmarried children under 26 years of age or for 2 years after the end of the calendar year in which such persons last qualified as dependents under 26 U.S.C. 106, whichever occurs first, and any child nineteen years of age or over who is mentally or physically incapable of earning his own living, provided that an additional premium is paid for the coverage of such handicapped child. Said definition shall also include an unmarried child, nineteen years of age or over, who is a full-time student in an educational or vocational institution and whose program of education has not been substantially interrupted by full-time employment, excluding service in the armed forces. The standards for such full-time instruction and the time required to complete such program of education shall be determined by the commission. Contributions toward the total monthly premium or rate applicable to the health insurance coverage for a full-time student shall be as provided for in section eight, but such contribution shall cease upon the student's attainment of age twenty-four or the following June thirtieth of the year in which the student attains said age; however, at the option of the employee, such coverage may be continued beyond said age or date provided that the total monthly premium or rate is paid in full by the employee and the method of payment by the active or retired employee shall be as determined by the commission. Said definition shall further include the parents of an employee, or an employee who retired on or after January first, nineteen hundred and fifty-six, who are dependent upon him for over one half of their annual maintenance and support, proof of which shall be furnished to the satisfaction of the commission upon its request. The commission shall establish a separate schedule of hospital, surgical, medical, dental and other health insurance benefits for dependent parents, and the claim experience applicable thereto shall be maintained separately from the schedule of hospital, surgical, medical, dental and other health insurance benefits and claim experience applicable to employees insured hereunder. Payment of the premium applicable to the schedule of hospital, surgical, medical, dental and other health insurance benefits for dependent parents shall be made to the commission without contribution by the commonwealth. Any person who fraudulently claims to furnish over one half of the maintenance and support of a dependent parent which claim results in the parent becoming insured hereunder, shall, upon the determination by the commission, forfeit his eligibility for insurance coverage under this chapter for a period of not less than one or more than three years from the date of such determination. (e) A person is deemed to work a regular work week of permanent employment when he meets the applicable requirements of section five of chapter eight, sections thirty and thirty A of chapter one hundred and forty-nine, or any general or special law pertaining to a regular work week of permanent employment; or whose duties require no less than eighteen and three-quarters hours, regularly, in the service of the commonwealth during the regular work week in a position for which the established regular work week is thirty-seven and one-half hours; or whose duties require no less than twenty hours, regularly, in the service of the commonwealth during a regular work week in a position for which the established regular work week is forty hours. In the event that a department head is unable to apply the terms defined above to a specific set of circumstances all facts relative thereto shall be submitted to the commission for a determination of eligibility and such determination shall be final. (f) "Elderly governmental retirees'', employees of the commonwealth, housing and redevelopment authorities, mosquito control projects and technicians of the National Guard retired prior to the effective date of contracts or agreements issued under this chapter who are receiving a pension or retirement allowance from the commonwealth sufficient from which a monthly insurance premium may be withheld; and employees of counties, cities, towns and districts including "teachers'' as defined in section one of chapter thirty-two, retired prior to the effective date of contracts or agreements issued under the provisions of chapter thirty-two B as, or when, adopted by the political subdivision from which they are retired, and who are receiving a pension, annuity or retirement allowance sufficient from which a monthly insurance premium may be withheld. (g) "Optional medicare extension'', a program of hospital, surgical, medical, dental and other health insurance for such active and retired employees of the commonwealth and their dependents, and such active and retired employees of certain counties, cities, towns and districts and their dependents as are eligible or insured under the federal health insurance for the aged act as may be amended from time to time. (h) "Health care organization'', an organization, including without limitation a health maintenance organization for the group practice of medicine, with or without hospital or other medical institutional affiliations, which furnishes to the patient a specified or unlimited range of medical, surgical, hospital and other types of health care services. (h1/2) "Primary care provider'', a health care professional qualified to provide general medical care for common health care problems who; (1) supervises, coordinates, prescribes, or otherwise provides or proposes health care services; (2) initiates referrals for specialist care; and (3) maintains continuity of care within the scope of practice. (i) "Wellness program'', a program designed to measure and improve individual health by identifying risk factors, principally through diagnostic testing and establishing plans to meet specific health goals which include appropriate preventive measures. Risk factors may include but shall not be limited to demographics, family history, behaviors and measured biometrics.

M.G.L. c. 32A, § 3 Group insurance commission

c. 32A, § 3. Group insurance commission Section 3. There shall be established within the executive office of administration and finance, but not under its jurisdiction, a special unpaid commission, to be known as the group insurance commission, consisting of the commissioner of administration and finance, the commissioner of insurance, and 13 members to be appointed by the governor, 1 of whom shall be a retired state employee, 1 of whom shall be a health economist and at least 3 of whom shall be full-time state employees, 1 shall be a member of the Massachusetts Public Employees Council, #93, AFSCME, Massachusetts State Labor Council, AFL–CIO, 1 shall be a member of the Massachusetts State Employees Association, NAGE, and 1 shall be a member of Local 254, S.E.I.U., 1 of whom shall be a management representative appointed from a list of 3 representatives nominated by the Massachusetts Municipal Association and 1 of whom shall be a labor representative appointed from a list of 3 representatives nominated by the president of the teachers' union with the greatest amount of active and retired members enrolled in commission health plans. In addition, upon the transfer of 45,000 subscribers from municipal governmental units to the group insurance commission pursuant to section 19 of chapter 32B, there shall be an additional management representative appointed by the governor from a list of 3 representatives nominated by the Massachusetts Municipal Association and an additional labor representative appointed by the governor from a list of 3 representatives of municipal public safety employees nominated by the president of the Massachusetts Chapter of the AFL–CIO. Whenever an organization nominates a list of representatives for appointment by the governor under this section, the organization may nominate additional candidates if the governor declines to appoint any of those originally nominated. Not more than 55 per cent of the appointive members of the commission shall be members of the same political party. No member appointed by the governor shall be an insurance agent, broker, employee or officer of an insurance company. Upon the expiration of the term of office of an appointive member, his successor shall be appointed in like manner for a term of 3 years. The commission shall be provided with suitable offices and may, subject to appropriation, incur expenses and appoint an executive director who shall be the executive and administrative head of the commission and who shall not be subject to chapter 31. The commission may authorize the executive director to appoint such employees as may be necessary to administer this chapter. There shall be paid by the commonwealth to each appointive member of the commission the necessary expenses actually incurred in the discharge of his official duties. The commission shall adopt such reasonable rules and regulations as may be necessary for the administration of this chapter and shall make an annual report to the governor and to the general court which shall include any modifications or amendments made to contracts executed under this chapter. The rules and regulations shall be in such form as to enable employees to understand the benefits available from the insurance program, including the cost thereof.

M.G.L. c. 32A, § 3A Employees' advisory committee

c. 32A, § 3A. Employees' advisory committee Section 3A. There shall be within the group insurance commission, but not under its direction or control, an unpaid advisory committee to be known as the employees' advisory committee consisting of a representative duly elected or appointed to membership on said committee by organizations of employees and retirees whose membership consists of employees or retirees insured under this chapter. Said committee shall elect a chairman and other officers from its membership and shall establish procedures for the conduct of its deliberations including a method to provide a reasonable opportunity for all interested employees and retirees to meet with it so that the conclusions and recommendations of the committee will be a fair representation of the interests of all persons insured under this chapter. The commission, upon request by the committee, shall provide space, if possible, within the offices occupied by the commission for the conduct of the meetings of said committee. The employee advisory committee, at least once each calendar year, or upon request by the commission, shall furnish the commission with a list of its officers and members indicating their organizational representation and affiliation. The committee from time to time may submit to the commission for consideration and necessary action any recommendations relative to the insurance programs administered by the commission. Upon request by the governor, the committee may submit the names of nominees from its membership or from the organizations represented therein to serve as members of the commission as provided under section three. The provisions of chapter thirty A shall not be applicable to the employees' advisory committee.

M.G.L. c. 32A, § 3B Applicability of chapter to Commonwealth charter schools and education collaboratives

c. 32A, § 3B. Applicability of chapter to Commonwealth charter schools and education collaboratives Section 3B. This chapter shall become effective for a commonwealth charter school by a majority vote of its board of trustees and, for an education collaborative, by a majority vote of its board of directors.

M.G.L. c. 32A, § 4 Purchase of insurance policies by commission

c. 32A, § 4. Purchase of insurance policies by commission Section 4. The commission shall negotiate with and purchase, on such terms as it deems to be in the best interest of the commonwealth and its employees, from one or more insurance companies, savings banks or non-profit hospital or medical service corporations, a policy or policies of group life and accidental death and dismemberment insurance covering persons in the service of the commonwealth, and group general or blanket insurance providing hospital, surgical, medical, dental and other health insurance benefits covering persons in the service of the commonwealth and their dependents, and shall execute all agreements or contracts pertaining to said policies or any amendments thereto for and on behalf and in the name of the commonwealth. Said commission may negotiate a contract for such term not exceeding five years as it may, in its discretion, deem to be the most advantageous to the commonwealth; provided, however, that the portion of the cost of the premium per month to be borne by the commonwealth shall not exceed the estimated monthly cost for which funds have been appropriated by the general court for the then current fiscal year. For the purposes of this chapter, any nonprofit hospital service corporation or nonprofit medical corporation organized under chapter one hundred seventy-six A or one hundred and seventy-six B shall be and is hereby authorized to enter into a reinsurance agreement as herein provided in the same manner as any other insurance company.

M.G.L. c. 32A, § 4A Administrative services contracts

c. 32A, § 4A. Administrative services contracts Section 4A. The commission when providing hospital, surgical, medical, dental and other health insurance coverage as authorized by this chapter may, in lieu of or in addition to entering into the insurance policies, agreements or contracts described in this chapter, enter into an administrative services or similar contract with an insurance carrier, non-profit hospital or medical service corporation, health maintenance organization, preferred provider organization, independent practice association or other third-party health care administrators. If deemed by the commission to be in the best interest of the commonwealth and its active and retired employees and their eligible dependents, the commission may enter into such service-type contracts for a period not to exceed five years.

M.G.L. c. 32A, § 4B Retroactive claims denials for behavioral health services

c. 32A, § 4B. Retroactive claims denials for behavioral health services Section 4B. (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 or substance use disorder treatment program licensed by the department of public health under chapters 17, 111, 111B or 111E; or (ii) a behavioral, substance use disorder or mental health professional who is licensed under chapter 112 and accredited or certified to provide services and who has provided services under an express or implied contract or with the expectation of receiving payment, other than co-payment, deductible or co-insurance, directly or indirectly from the commission or other entity. ''Retroactive claims denial'', as defined in section 1 of chapter 175. (b) The commission or an entity with which the commission contracts to provide or manage health insurance benefits, including mental health and substance use disorder services, shall not impose a retroactive claims denial for behavioral health services on a provider unless: (i) less than 12 months have elapsed from the time of submission of the claim by the provider to the commission or other entity responsible for payment; (ii) the commission or other entity has furnished the provider with a written explanation of the reason for the retroactive claims denial and, where applicable, a description of additional documentation or any other corrective action required for payment of the claim; and (iii) where applicable, the commission or other entity responsible for payment allows the provider 30 days to submit additional documentation or to take any other corrective action required for payment of the claim. (c) Notwithstanding subsection (b), a retroactive claims denial may be allowed after 12 months if: (i) the claim was submitted fraudulently; (ii) the claim, or services for which the claim was submitted, is the subject of legal action; (iii) the claim payment was incorrect because the provider or the insured was already paid for the health care services identified in the claim; or (iv) the health care services identified in the claim were not delivered by the provider. (d) If a retroactive claims denial is imposed because the claim payment is subject to adjustment due to expected payment from a payer other than the commission or an entity with which the commission contracts to provide or manage health insurance benefits, including mental health and substance use disorder services, the commission or other entity shall notify the provider not less than 15 days before imposing the retroactive claims denial. The provider shall have 12 months from the date of denial to determine whether the claim is subject to payment by a secondary insurer; provided, however, that if the claim is denied by the secondary insurer due to the insured's transfer or termination of coverage, the commission shall allow for resubmission of the claim.

M.G.L. c. 32A, § 5 Insurance and medicare benefits of state employees

c. 32A, § 5. Insurance and medicare benefits of state employees Section 5. Each employee shall be automatically insured for $10,000 of group life insurance and $10,000 of group accidental death and dismemberment insurance and group general or blanket insurance providing hospital, surgical, medical, dental and other health insurance benefits provided under said policy or policies, commencing on the date he first becomes eligible or on the effective date of such coverage or coverages, including dependent benefits, whichever last occurs; provided, that any employee desiring not to be so insured shall, on an appropriate form prescribed by the commission, give written notice to the commission that he is not to be insured for such coverages, including dependent benefits, provided under such policy or policies. Such notice shall be mailed to the office of the commission at least thirty days prior to the effective date the employee becomes eligible or insured. If an employee fails to give such notice or, if an employee desires to terminate said insurance, he may withdraw, and such insurance benefits shall cease to be effective on the date to which the premium has been paid. In determining said date, payroll deductions or direct payments on behalf of the employee shall continue to be made until the expiration of fifteen days from the receipt of notice of withdrawal by the commission. When an employee insured under this section becomes eligible for health insurance coverage, as provided in section ten C, he may terminate by notice, as aforesaid, his hospital, surgical, medical, dental and other health benefits provided herein and retain his $10,000 of group life insurance and $10,000 of group accidental death and dismemberment insurance. Every policy whether original or renewal shall, in the case of employees who immediately prior to the effective date of such original or new policy were covered by group insurance benefits under this chapter, provide protection by continuing uninterrupted coverage without regard to waiting periods for benefits.

M.G.L. c. 32A, § 6 Amounts of insurance and benefits; determination; alterations or reductions; separability

c. 32A, § 6. Amounts of insurance and benefits; determination; alterations or reductions; separability Section 6. The amount of group life insurance on each employee shall be $10,000, and the amount of group accidental death and dismemberment insurance on each employee shall be $10,000, except that those employees desiring to elect optional coverage in excess of $10,000 group life insurance and $10,000 group accidental death and dismemberment insurance may do so as provided in section ten A. The amount of the hospital, surgical, medical, dental and other health insurance benefits to be provided each employee and his dependents shall be determined by the commission as provided under sections four and ten C. For active and retired employees, their dependents and the survivors of deceased employees, including municipal subscribers, except as otherwise required by state or federal law, and except effective July 1 of any year, the commission shall not alter the schedule of copayments and deductibles for health plans, or alter any other terms relating to health plans which would require authorization by vote of the commissioners but, for health plans whose rates change on January 1 instead of July 1, the commission may make such changes effective January 1. If the governor reduces allotments to the commission under section 9C of chapter 29, the commission may make any necessary adjustments to account for the reduction, but the commission shall not alter the contribution ratios provided in the most recent applicable appropriation act. As determined by the rules and regulations of the commission, all insurance coverages authorized by this chapter may be considered separable for employee, retiree or deferred retiree application and eligibility purposes.

M.G.L. c. 32A, § 7 Information furnished commission by employees

c. 32A, § 7. Information furnished commission by employees Section 7. Each employee to whom this chapter applies shall furnish the commission, in such form as it shall prescribe, such information as is necessary to enroll himself, or himself and his dependents, under the policy or policies of insurance.

M.G.L. c. 32A, § 8 Contributions for premiums by commonwealth and active or retired employees and dependents; ratio; withholding; direct payment; reimbursement by certain agencies; filing copies of contracts and agreements

c. 32A, § 8. Contributions for premiums by commonwealth and active or retired employees and dependents; ratio; withholding; direct payment; reimbursement by certain agencies; filing copies of contracts and agreements Section 8. For policies of group life insurance and accidental death and dismemberment insurance, and group health insurance purchased by the commission in accordance with the provisions of sections four, five and ten C, the commonwealth, on behalf of active and retired employees and their dependents, shall contribute no less than seventy-five per cent of the total monthly premium or rate applicable to said coverages and the active and retired employees on behalf of themselves or themselves and their dependents shall contribute the remaining twenty-five per cent of the total monthly premium or rate, except, that upon approval by way of an annual, or more frequent appropriation act, the commonwealth may contribute more than seventy-five per cent but less than the entire total monthly premium or rate. Each appropriation act as may be applicable, shall provide the necessary sum based upon the estimated monthly cost as required by section four and shall describe the ratio of contribution to be paid by the commonwealth and by the active and retired employees insured under the aforesaid sections. The description of the ratio may include a condition that if, as a result of a change in the total monthly premium or rate which occurs during the current or ensuing fiscal year from a change in a contract between the commission and the insurance carrier or carriers, the amount of the contribution paid by the active and retired employee and dependents is to remain unchanged and the difference in the amount thus paid and the total monthly premium or rate as changed is to be added to, or deducted from as the case may be, the contribution by the commonwealth. The aforesaid ratio shall continue until changed by a subsequent appropriation act and the aforesaid sum shall also include the commonwealth's contribution of the total monthly premium or rate required for coverages contained in other sections of this chapter as such contribution is provided in said sections. With respect to any period of insurance authorized by this chapter which is in effect for an active employee and dependent, there shall be withheld from each payment of salary or wages no more than twenty-five per cent of the aforesaid total monthly premium or rate, or, there shall be a lesser amount as provided in the most recent applicable appropriation act. With respect to any period of insurance authorized by this chapter which is in effect for a retired employee and dependent, there shall be withheld from each payment of pension or retirement allowance no more than twenty-five per cent of the aforesaid total monthly premium, or, there shall be withheld a lesser amount as provided in the most recent applicable appropriation act. The commonwealth shall contribute a share of any additional premium which may be required for coverage of an employee's dependent child who is nineteen years of age or over and mentally or physically incapable of earning his own living, such share equalling the same ratio as that paid on behalf of an active or retired employee and dependent. If an employee is entitled to receive, during a calendar month, salary, wages or other compensation and the premium has not been withheld from said salary, wages or other compensation, he may continue his insurance in effect by paying directly to the commission the premium which would otherwise have been deducted from his salary, wages or other compensation. If an employee is not entitled to receive salary, wages or other compensation for a calendar month, he shall for the purposes of this chapter be deemed to have been granted a leave of absence without pay and shall make payment for the entire total monthly premium or rate of his insurance to the commission as aforesaid and there shall be no contribution by the commonwealth for such employee's insurance. If an employee has been granted a military leave of absence because said employee is a member of the army national guard or air national guard, or a reservist in the armed forces of the United States called to active service in the armed forces of the United States subsequent to August second, nineteen hundred and ninety, for purposes of this chapter he shall be deemed to have been granted leave without pay, and subject to the rules and regulations of the commission, said employee shall make payment of the portion of the total monthly premium or rate that would otherwise have been deducted from his salary, wages or other compensation. If an employee is not entitled to receive salary, wages or other compensation for any calendar month, due to illness of such employee and not because of illness of his immediate family, for purposes of this chapter he shall be deemed to have been granted sick leave without pay, and subject to the rules and regulations of the commission, said employee shall make payment of the portion of the total monthly premium or rate that would have otherwise been deducted from his salary, wages or other compensation. For purposes of this section, the term ''active service'' shall not include active duty for training in the army national guard or air national guard or as a reservist in the armed forces of the United States. All amounts withheld from an employee's salary or wages as provided in this section and all amounts withheld from pensions or retirement allowances under the provisions of section 19 of chapter 32 shall be forwarded by the department, institution, or other agency responsible for the payment of employee salaries and wages or pensions and retirement allowances to the commission. All amounts withheld from the optional retirement plans of participating retirees pursuant to section 40 of chapter 15A shall be forwarded directly to the commission by the optional retirement program plan providers. The commission may place all such amounts withheld or paid directly in interest bearing accounts. Any current and future interest earned on such amounts shall be deposited by the commission in the group insurance commission trust fund and maintained separately as a special account subject to the terms of investment and expenditure as provided in section 9A. Such interest shall not be classified under section 9 as a dividend, its equivalent or other refund or rate credits. A statement of all funds so placed, any current and future interest earned thereon, and the purposes for which such interest is expended shall be included in the annual report of the commission as required by section 3. The Massachusetts Parking Authority, the metropolitan area planning council, the Montachusett regional planning commission, the central Massachusetts regional planning district commission, the Massachusetts State College Building Authority, Worcester county, the county cooperative extension service of Suffolk county, local housing authorities and redevelopment authorities, and all other non-state-funded agencies and authorities shall reimburse the commonwealth for all contributions made on behalf of their employees and retirees including the applicable administrative expense as determined by the commission. The commission, from funds appropriated therefor, may empower the executive director to authorize payment of the contribution of the commonwealth as provided above, which, together with the employee and retiree payments, shall be paid at least once each month to the carrier or carriers entitled to the total monthly premium. Every department, board, or agency of the commonwealth shall, on or before August first of each year, file with the commission a true copy of all existing contracts or agreements of every nature and description with the commonwealth or a political subdivision of federal, trust and any other nonstate funds. For contracts or agreements entered into on and after July first of each year, true copies shall be filed with the commission no later than sixty calendar days from the effective date thereof. If a secretariat, department, board or agency fails to file a copy of such contract, or fails to respond to a reasonable inquiry by said commission, the commission shall provide a fair hearing to the head of the operating agency to determine the justification for noncompliance. Upon continued failure by the secretariat, department, board or agency head to provide the requested data and information, the commission may vote to withhold payment of the commonwealth's share of the insurance premium applicable to the insured employees of the agency and all such employees only for purposes of payment of insurance premiums, shall be deemed to be absent without pay and shall make payment of the required premiums as provided in this section.

M.G.L. c. 32A, § 8A Employees on leaves of absence for more than one year; insurance costs charged to employing agency

c. 32A, § 8A. Employees on leaves of absence for more than one year; insurance costs charged to employing agency Section 8A. The secretary of administration and finance is hereby authorized and directed to charge all agencies for the commonwealth's share of the health insurance costs incurred on behalf of any employees of that agency who are on leave of absence for a period of more than one year and to notify the comptroller of such charges and such leaves of absence. The comptroller is hereby authorized and directed to transfer said amounts to the General Fund.

M.G.L. c. 32A, § 9 Dividends, refunds, rate credits; deposit in special funds; transfer of reserves

c. 32A, § 9. Dividends, refunds, rate credits; deposit in special funds; transfer of reserves Section 9. Any dividend, its equivalent or other refunds or rate credits, accepted by the commission from the carrier or carriers, shall be deposited by the commission with the state treasurer and shall be maintained in a separate fund to be known as the group insurance commission trust fund. Using the net premium paid to the carrier or carriers as a basis of computation, the commission shall determine the pro rata share of such dividend, other refunds or rate credits which shall be allocable (1) to the commonwealth's net share of the premium paid, and (2) to the federal or other funds contributed in the place of the commonwealth's gross share of the premium cost, after deducting the pro rata administrative cost. The commission shall compute the pro rata administrative cost by determining the total administrative cost to the commonwealth of the entire insurance program authorized by this chapter which is applicable to the period for which the dividend, other refunds or rate credits have been received, and by using the commonwealth's gross share of the premium cost as a basis, shall apply that portion of the total administrative cost which is applicable to federal or other funds contributed in place of the commonwealth's gross share of the premium cost. If, after applying the above formula, it is determined that the administrative cost allocable to the commonwealth is greater than the dividend, other refund or rate credits received, the entire amount thus received shall, upon authorization by the commission, be paid by the state treasurer into the General Fund, and the commission shall charge those departments, divisions and political subdivisions which have federal or other funds allocated to them for this purpose with said excess administrative cost. Whenever the pro rata share of the dividend allocable to the federal or other funds contributed in place of the commonwealth's gross share of the premium cost is in excess of the applicable administrative cost, the state treasurer, upon authorization by the commission, shall make payment to said funds of the amount of said excess dividend. Whenever the pro rata share of the dividend allocable to the commonwealth's net share of the premium paid is in excess of the total administrative cost plus the excess dividend, computed on the ratio of the net premium paid by the commonwealth to the total net premium paid to the carrier or carriers such sum shall, upon authorization by the commission, be paid by the state treasurer into the General Fund. The balance of the excess dividend which is the ratio of the net premium paid by the insured employees and retired employees to the total net premium paid to the carrier or carriers shall be retained in the group insurance commission trust fund to be invested on behalf of the insured employees and retired employees as authorized by the investment committee established in section nine A or disbursed on behalf of the insured employees and retired employees as determined by the commission. Where the terms and conditions of a policy or policies of group life and accidental death and dismemberment insurance and group general or blanket hospital, surgical, medical, dental and other health insurance as authorized by this chapter provide for the establishment, revival or continuance of a special claims or rate stabilization reserve customarily developed by an insurance carrier on behalf of the commission from one or more periods of experience accounting and therefore not classified under this section as a dividend, its equivalent or other refund or rate credit, the commission, upon conclusion of the period of the contract or termination of such policy or policies, may transfer said reserve to the new policy or policies with the same or different insurance carrier or carriers, or, the commission may require the transfer of such reserves to its own custody and control in which event said reserves shall be deposited by the commission in the group insurance commission trust fund and maintained separately as a special claims or rate stabilization reserve subject to the conditions of investment and expenditure as provided in section nine A.

M.G.L. c. 32A, § 9A Investment committee; investment and deposit of funds by state treasurer

c. 32A, § 9A. Investment committee; investment and deposit of funds by state treasurer Section 9A. There shall be an unpaid investment committee which shall have general supervision of the investment of funds retained in the group insurance commission trust fund to be used on behalf of the insured employees. Such committee shall consist of the state treasurer, who shall be a member ex officio, the members of the group insurance commission who shall be members ex officio, and one other person who shall be chosen by the aforementioned members, for a term of three years and who shall be qualified by training and experience in the investment of funds as a result of having been principally employed in such occupation for a period of at least ten years. The chairman of the investment committee shall be chosen from among its members. Each member of such committee shall continue to hold office until the expiration of his term and until the qualification of his successor. The executive director of the commission shall perform the duties of secretary of the investment committee. The commission shall furnish such clerical assistants as may be required to carry on the work of the investment committee. Subject in each instance to the approval of the investment committee established under the provisions of this section, the state treasurer shall invest and reinvest such funds to the extent not required for current disbursements as authorized by section nine in bonds, notes or other securities which are legal for the investment of funds of savings banks under the laws of the commonwealth. Not more than twenty-five per cent of the total funds of the trust fund shall be invested in bank stocks or bank holding company stocks nor shall more than one-half of said twenty-five per cent be invested in the stock of any one bank or bank holding company. The treasurer may deposit any portion of the monies to be invested, in savings banks, co-operative banks or in savings deposits in trust companies, lawfully doing business in the commonwealth for one year or more, subject, however, to the limitations set forth in section three of chapter one hundred and sixty-seven D, and may invest such funds in shares of federal savings and loan associations lawfully doing business in the commonwealth for one year or more, but the amount so invested in any one federal savings and loan association shall not at any time exceed the sum of ten thousand dollars. The commission shall have power to expend such funds which in its discretion is in the best interests of the insured employees and retired employees. The state treasurer shall make payment of such funds as authorized by the commission. A statement of all funds received, invested and expended on behalf of the insured employees shall be included in the annual report of the commission as required by section three.

M.G.L. c. 32A, § 10 Retirement or termination of employment; effect on policy; conversion of insurance

c. 32A, § 10. Retirement or termination of employment; effect on policy; conversion of insurance Section 10. The commission shall require that, upon retirement of an employee, the policy or policies of insurance as set forth in section six, except the optional group life insurance referred to therein, shall provide that the $10,000 of group life insurance, the $10,000 of group accidental death and dismemberment insurance and the group general or blanket insurance providing hospital, surgical, medical, dental and other health insurance, as provided under sections five and ten C, as may be applicable, shall be continued, provided said retiree makes application to the commission on a form prescribed by the rules and regulations of the commission. The retired employee shall make payment of an amount of the total monthly premium as provided in section eight and the commonwealth shall contribute the remaining amount of the total monthly premium said total being the average group premium as determined by the commission for such group life and accidental death and dismemberment insurance as well as the average group premium as determined by the commission for the hospital, surgical, medical and other health insurance for such retired employee or for such retired employee and his dependents. For services of a health care organization as provided under section fourteen, the retired employee shall pay the remainder of the total monthly premium after deducting the amount contributed by the commonwealth to the extent provided in section eight. The contribution by the commonwealth for services of a health care organization shall be equal to and shall not exceed the contribution of the commonwealth for group or blanket health insurance as provided under section five or section ten C. Prior to retirement, an insured employee who terminates his service with the commonwealth and who has a right to retire but whose retirement is deferred as provided in section ten of chapter thirty-two shall for the purposes of this chapter only be deemed to have been granted a leave of absence without pay, and may continue all insurance coverages to which he would have been entitled if he had not terminated his services; provided he files an application therefor with the commission, and makes payment for the entire cost of such insurance, with no contribution by the commonwealth, to the commission in such manner as it may prescribe. Any National Guard technician in the service of the United States who is eligible and makes application for a pension or annuity allowance and whose application is approved by the state retirement board in accordance with the provisions of chapter thirty-two shall be entitled to be insured under this chapter as a retired employee without regard to waiting periods for benefits or medical qualification as if said retiree had been in the service of the commonwealth; but, if a National Guard technician eligible for coverage under this chapter dies prior to becoming insured as aforesaid, his surviving spouse shall be eligible for coverage as provided in section eleven. Any policy or policies issued under this chapter shall provide that, on termination of employment, an employee shall be entitled to convert his insurance to an individual type of policy, subject to the provisions of section one hundred and thirty-four of chapter one hundred and seventy-five with respect to life insurance, and subject to the requirements of the commission with respect to the other insurance coverages provided in this chapter, except that with respect to the services of a health care organization, the contract made under section fourteen may provide for extension or continuation of coverage in lieu of the right to convert. No employee will be permitted to convert his insurance or extend or continue coverage for services of a health care organization on separation from service more than one time, if such converted or extended insurance would result in a greater amount of insurance than is provided in section six or section fourteen respectively.

M.G.L. c. 32A, § 10A Additional insurance

c. 32A, § 10A. Additional insurance Section 10A. Each employee insured for the minimum amounts of group life and group accidental death and dismemberment insurance provided in section six may, subject to such conditions as the commission shall approve, be insured for amounts of group life insurance and group accidental death and dismemberment insurance in addition to the minimum amounts provided for in said section six. An employee may be insured for additional insurance in thousand dollar incremental amounts up to an amount equal to one thousand dollars less than the employee's gross annual salary rounded down to the nearest whole thousand dollars or for an amount equal to one thousand dollars less than two times, three times, four times, five times, six times, seven times, or eight times the employee's gross annual salary rounded down to the nearest whole thousand dollars. The group insurance commission is hereby authorized to implement a system whereby such employee contributions for such insurance are made on a pre-tax basis. Notwithstanding the maximum dollar limits of the aforesaid amounts of group accidental death and dismemberment insurance and subject to such provisions of the group policy as may be provided by the commission, if a death occurs to an employee while in the performance of his duties and if such death occurs as the natural and proximate result of a robbery or attempted robbery a further additional amount of accidental death insurance shall be payable in an amount equal to three times the sum of additional group life and group accidental death and dismemberment insurance applicable to said employee insured under this section. Such additional insurance shall be issued by the carrier or carriers as determined by the commission without regard to a minimum number of eligible employees or to the provisions of chapter one hundred and seventy-five. Each employee entitled to additional insurance under this section shall file an application therefor with the commission on an appropriate form prescribed by the commission, except that an employee having such additional insurance who becomes entitled to further additional insurance hereunder by reason of an increase in annual salary shall automatically be insured for the amount of such further additional insurance, to become effective on the first day of the second month following the month in which the increase was authorized, or, on the first day of the earliest subsequent month in which the increase was authorized if as determined by the commission, the aforesaid effective date of authorization prevents timely withholdings from payrolls of the increased premium, unless the employee notifies the commission in writing on a form prescribed by it that he is not to be so insured; provided, however, that such increase in salary has been authorized for a period of time in excess of one year. No reduction in the amount of insurance shall be required on account of a reduction in compensation. For purposes of this additional insurance, yearly gross salary or compensation shall not include any overtime pay and in the case of hourly workers shall be computed on the basis of scheduled required work hours. With respect to any additional insurance which is in effect for an employee there shall be withheld from each payment of salary or wages of such employee the premium for such insurance and the commonwealth shall make no contribution to said premium. If an employee is not entitled to receive salary, wages or other compensation for a calendar month, he shall make payment directly to the commission and there shall be no contribution by the commonwealth for such payment. An employee insured under this section may by written notice on a form prescribed by the commission cancel such insurance, and such insurance shall require no further premium payment the first day of the month following the expiration of fifteen days from the receipt of notice of cancellation. Insurance coverage will therefore terminate at the end of the month for which premium has been paid. If an employee withdraws as provided in section five, such withdrawal shall automatically effect a cessation of the additional insurance under this section as of the date of cessation of his minimum insurance. Upon retirement of an employee eligible for pension allowance under any general or special law, his additional insurance under this section shall be continued; provided, however, that payment of the appropriate premium as established by the commission has been paid by such retiree. A retiree who, for reasons other than for non-payment of premiums, terminates his insurance under this section shall be entitled to a conversion privilege as provided in section ten. A person who has retired and whose insurance under this section has been terminated may be reinstated for the amount of insurance in force at the time of retirement; provided, however, that said retiree submits proof of his physical condition satisfactory to the commission, or in lieu of submission of proof of physical condition, forfeits the amount of insurance which has been converted to a non-group policy as hereinbefore authorized. The commission is hereby authorized to negotiate for and purchase the additional insurance outlined in this section on the basis of group renewable term or group permanent insurance, whichever it deems to be in the best interests of the commonwealth and its employees.

M.G.L. c. 32A, § 10B Insurance for elderly government retirees and their dependents

c. 32A, § 10B. Insurance for elderly government retirees and their dependents Section 10B. The commission shall negotiate with and purchase on such terms as it deems to be in the best interest of the commonwealth, certain political subdivisions that have accepted the provisions of this section, and the elderly governmental retirees and their dependents, from one or more insurance companies or non-profit hospital, medical or other service corporations, a policy or policies of group general or blanket insurance providing hospital, surgical, medical, dental and other health insurance benefits for said retirees and their dependents. Such policy or policies shall consist of a schedule of hospital, surgical, medical, dental and other health insurance benefits for elderly governmental retirees and their surviving spouses which may be related to the schedule of hospital, surgical, medical, dental and other health insurance benefits purchased by the commonwealth under the provisions of sections 4, 4A and 10C, or the schedule of hospital, surgical, medical, dental and other health insurance benefits purchased by counties, cities, towns and districts under the provisions of section three of chapter thirty-two B. Such schedule of benefits for elderly governmental retirees may include the payment of any premium which may be required by the federal health insurance for the aged act to be paid by the enrollee thereof. The agreement between the carrier and the commission for said policy or policies may provide in addition to agreed, set, or stated monthly premium applicable to the aforementioned schedule a surcharge or subsidiary rate. The commission shall execute all agreements or contracts pertaining to said policy or policies or any amendment thereto for and on behalf and in the name of the commonwealth, for a period not exceeding five years; provided, however, that the portion of the cost of the monthly premium, and surcharge or subsidiary rate applicable to employees retired from the service of the commonwealth as enumerated in paragraph (b) of section two to be borne by the commonwealth shall not exceed the estimated monthly cost for which funds have been appropriated or otherwise made available by the general court for the then current fiscal year. (a) With respect to any period of insurance which is in effect for the elderly governmental retiree, notwithstanding the provisions of section nineteen of chapter thirty-two or any other general or special law to the contrary, there shall be withheld from each monthly payment of pension, annuity or retirement allowance by the respective retirement system or by the appropriate retiring authority, fifty per cent of the premium for such insurance, and the commonwealth shall make primary payment of the remaining fifty per cent of said premium subject to reimbursement as outlined in (c) below. (b) The retiree's fifty per cent share of the premium shall be withheld by the appropriate authority from the retiree's pension, annuity or allowance under the state employees' retirement system, the teachers' retirement system, the retirement system established in the county, city, town or district, and under any non-contributory pension or annuity, and shall be forwarded by the responsible governmental official to the commission in accordance with its rules and regulations. The commission shall make primary payment of the remaining fifty per cent of said premium together with the surcharge or subsidiary rate, subject to reimbursement as outlined in paragraph (c). (c) The commission shall determine at least annually, or sooner, the amount of premiums and surcharge or subsidiary rates which shall be reimbursed to the commonwealth by agencies thereof, by housing and redevelopment authorities and counties, cities, towns and districts, having elderly governmental retirees insured under this section. The commission shall also determine, at least annually, the portion of the commission's expense of administering this hospital, surgical, medical, dental and other health insurance coverage for elderly governmental retirees applicable to the agency, authority or political subdivision from which they retired. After such determinations, the commission shall certify the amounts determined as aforesaid to the state treasurer for assessment. The state treasurer shall issue his warrant in the manner provided by section twenty of chapter fifty-nine requiring the cities and towns concerned to pay into the treasury of the commonwealth the amounts of such premium, surcharge or subsidiary rate and administrative expenses attributable to such cities and towns. In the case of counties, the commission on or before December fifteenth in each year shall notify the county commissioners of each county of the amount of premium, surcharge or subsidiary rate and the administrative expenses attributable to such county, and said amounts shall be included in the estimate of county receipts and expenses of said county; and reimbursement for said amounts shall be made to the state treasurer as prescribed by the commission. (d) Any dividend or refund accepted by the commission from the carrier as a result of the contract negotiated under this section, shall be deposited by the commission with the state treasurer as provided in section nine. The commission shall determine the amount of dividend or refund apportionable to the various counties, cities, towns and districts having elderly governmental retirees insured hereunder, and in the case of a city, town or district shall notify the state treasurer to reduce the premium charges and administrative expenses attributable to each such city, town or district by the amount of refund attributable thereto. In the case of counties, the commission shall notify the county commissioner of each county of the amount of refund attributable thereto and the estimate of receipts and expenditures for the ensuing year in each such county shall be reduced by the amount of such refund. If no premium is to be payable by a county, city, town or district for the succeeding year the commission shall certify the same to the state treasurer who shall pay over the amount of such refund to the political subdivision entitled thereto. The remaining portion of the dividend or refund apportionable to the commonwealth shall be applied as provided in section nine. (e) Each elderly governmental retiree to whom this chapter applies shall furnish the commission, in such form as it shall prescribe, such information as is necessary to insure himself or himself and his dependents under the hospital, surgical, medical, dental and other health insurance herein provided, and shall authorize the withholding of the appropriate premium from his pension, annuity or retirement allowance by the appropriate governmental authority. Each such retiree or his dependent may also authorize the withholding of any premium which may be required by the federal health insurance for the aged act, to be paid by any enrollee thereof, or make direct payment to the commission as it may determine, and the commission shall transmit all such amounts to the appropriate federal agency on behalf of such enrollee in a manner prescribed by said agency. (f) Upon the death of an elderly governmental retiree, the surviving spouse may continue the group hospital, surgical, medical, dental and other health insurance as provided under section eleven. (g) The rules and regulations of the commission which govern the administration of this section shall not be subject to the provisions of chapter thirty A.

M.G.L. c. 32A, § 10C Optional medicare extension

c. 32A, § 10C. Optional medicare extension Section 10C. The commission shall negotiate with and purchase on such terms as it deems to be in the best interest of the commonwealth, certain political subdivisions that have been approved by the commission for inclusion under this section, and the active and retired employees and their dependents insured or eligible to be insured under this chapter, including the surviving spouse of said employees who are eligible for coverage under the federal health insurance for the aged act, from one or more insurance companies or nonprofit hospital, medical, or other service corporations, a policy or policies of group general or blanket insurance providing hospital, surgical, medical, dental and other health insurance, to be known as optional medicare extension. Said policy or policies shall consist of one or more schedules of benefits which, as determined by the commission, may be related to the schedule of benefits purchased by the commonwealth under the provisions of section four, or the schedule of benefits purchased by counties, cities, towns and districts under the provisions of sections three and five of chapter thirty-two B. Such schedule of benefits may include on behalf of any person insured under this section the payment of any premium which may be required by the federal health insurance for the aged act, to be paid by any enrollee thereof. The claim experience of persons insured for optional medicare extension may, as determined by the commission, be maintained apart from, or made a part of, the claim experience applicable to the schedules of benefits provided under section four of this chapter, or sections three and five of chapter thirty-two B. The commission shall execute all agreements or contracts pertaining to said policy or policies or any amendment thereto, for and on behalf and in the name of the commonwealth, for such period not exceeding five years, as it may deem the most advantageous to the commonwealth; provided, however, that the portion of the cost of the premium to be borne by the commonwealth shall not exceed the estimated monthly cost for which funds have been appropriated by the general court for the then current fiscal year. Every policy whether original or renewal shall, in the case of all persons insured under this section who immediately prior to the effective date of such original or new policy were covered by group insurance benefits under this chapter or under chapter thirty-two B, provide protection by continuing uninterrupted coverage without regard to waiting periods for benefits. (a) Each person or his dependent to which this section applies shall furnish the commission, in such form as it shall prescribe, such information as is necessary to be insured for optional medicare extension, and shall authorize the withholding of the appropriate premium from salary, wages, compensation, pension, annuity or retirement allowance by the appropriate governmental agency or public authority. Each person may also authorize the withholding of any premium which may be required by the federal health insurance for the aged act, to be paid by any enrollee thereof, or may make direct payment to the commission as it may determine, and the commission shall transmit all such amounts to the appropriate federal agency on behalf of such enrollee in a manner prescribed by said agency. (b) With respect to any period of insurance authorized by this section which is in effect for an active employee or a retired employee and his dependent, payment for such insurance shall be made as provided in section eight. (c) With respect to any period of insurance authorized by this section which is in effect for an active employee or an active employee and his dependent of a county, city, town or district, notwithstanding any general or special law to the contrary, there shall be withheld from each monthly payment of salary, wages or other compensation by the appropriate public authority or the duly authorized representative thereof fifty per cent of the premium for such insurance and the commonwealth shall make primary payment of the remaining fifty per cent of said premium subject to reimbursement as authorized in paragraph (f). (d) With respect to any period of insurance authorized by this section which is in effect for a retired employee or a retired employee and his dependent of a county, city, town or district notwithstanding the provisions of section nineteen of chapter thirty-two or any other general or special law to the contrary, there shall be withheld from each monthly payment of pension, annuity or retirement allowance, by the respective retirement system or by the appropriate retiring authority, fifty per cent of the premium for such insurance, and the commonwealth shall make primary payment of the remaining fifty per cent of said premium subject to reimbursement as provided in paragraph (f). (e) All amounts withheld from the salary, wages or other compensation of an active employee of a county, city, town or district shall be forwarded at least as often as monthly by the responsible governmental official to the commission in a manner prescribed by it and all amounts withheld from the pension, annuity or retirement allowance of a retiree of a county, city, town or district shall be forwarded at least as often as monthly by the responsible governmental official of the teachers' retirement system, and of the retirement system established in a county, city, town or district as well as under any noncontributory pension or annuity to the commission in a manner prescribed by it. (f) The commission shall determine at least annually, or sooner, the amount of premiums which shall be reimbursed to the commonwealth by agencies thereof, by housing and redevelopment authorities and counties, cities, towns and districts having persons insured under this section. The commission shall also determine, at least annually, the portion of the commission's expense of administering this optional medicare extension program for such persons applicable to the agency, authority or political subdivision where they are employed or from which they have retired. After such determinations, the commission shall certify the amounts determined as aforesaid to the state treasurer for assessment. The state treasurer shall issue a warrant in the manner provided by section twenty of chapter fifty-nine requiring the counties, cities, towns and districts concerned to pay into the treasury of the commonwealth the amounts of such premium and administrative expenses attributable to such political subdivisions. The aforementioned manner of payment shall not prevent the commission, when deemed necessary, to require a political subdivision from making payment directly to the state treasurer. (g) Upon the death of an active or retired employee insured under this section, the surviving spouse may continue the insurance under this section, or the group hospital, surgical, medical, dental and other health insurance benefits provided under section five, whichever may be applicable, and the duration of such insurance, the determination and the amount of premium to be paid will be in accordance with section eleven. (h) Any dividend or refund, accepted by the commission from the carrier as a result of the contract negotiated under this section, shall be deposited by the commission with the state treasurer as provided in section nine. The commission shall determine the amount of dividend or refund apportionable to the various counties, cities, towns and districts having persons insured hereunder, and shall notify the state treasurer to reduce the premium charges and administrative expenses attributable to the applicable political subdivision by the amount of refund so applicable. If no premium is payable by a political subdivision for the succeeding year, the commission shall certify same to the state treasurer who shall pay over the amount of such refund to the political subdivision entitled thereto. (i) The commission may issue rules and regulations implementing the provisions of this section and such rules and regulations shall not be subject to the provisions of chapter thirty A.

M.G.L. c. 32A, § 10D Disability insurance; withholding payment of premiums

c. 32A, § 10D. Disability insurance; withholding payment of premiums Section 10D. The commission shall establish a plan of disability insurance on such terms and conditions as it deems to be in the best interest of the commonwealth and its employees. With respect to any disability insurance which is in effect for an employee there shall be withheld from the salary or wages of such employee the premium for such insurance and the commonwealth shall make no contribution to said premium. The group insurance commission is hereby authorized to implement a system whereby such employee contributions are made on a pre-tax basis.

M.G.L. c. 32A, § 10E Insurance for commonwealth employee granted leave to care for dependent child

c. 32A, § 10E. Insurance for commonwealth employee granted leave to care for dependent child Section 10E. The health and insurance benefits including, without limitation, policies of group life insurance group accidental death and dismemberment insurance, and the group general or blanket hospital, surgical, medical, dental and other health insurance as provided in this chapter for an employee of the commonwealth shall be continued for such employee for any period for which such employee is granted leave by his employer for the purpose of caring for such employee's minor dependent child under three years of age; provided, however, that, notwithstanding any general or special law, rule or regulation to the contrary, the employee shall make payment of the portion of the total monthly premium or rate that would have otherwise been deducted from his salary, wages or other compensation had such employee not taken such leave, and the commonwealth shall contribute the remaining amount of any such premium cost. For the purposes of this section, ''dependent child'' shall mean any child, whether natural, adoptive or a stepchild, of any such employee.

M.G.L. c. 32A, § 11 Death of employee or retired employee; continuation of insurance by spouse or dependent

c. 32A, § 11. Death of employee or retired employee; continuation of insurance by spouse or dependent Section 11. Upon the death of an employee or retired employee insured under this chapter, the surviving spouse, or the surviving dependent if there is no surviving spouse, or the surviving dependent if the surviving spouse subsequently dies, may continue the group general or blanket insurance providing hospital, surgical, medical, dental and other health insurance until the remarriage of said surviving spouse or, if there is no surviving spouse, until the surviving dependent becomes eligible for other group health coverage; provided, however, that application for such insurance coverage shall be filed with the commission and a method for the payment of premiums shall be determined in accordance with its rules and regulations; and provided, further, that the commonwealth shall contribute the same percent share of the total monthly premium or rate for coverage under this section as the percent share it contributes, pursuant to section eight, on behalf of retired employees, subject, where applicable, to reimbursement as provided under section ten B, and that eligible persons having elected coverage under this section shall pay the remainder premium or rate. Said commission shall determine the amount of said premium which may be the entire average group premium for hospital, surgical, and medical, dental and other health insurance applicable to an employee, an employee and his dependents, or a premium computed on a basis considered by said commission to be equitable in relation to all insured employees and all former employees who have retired and who have continued such coverage under the provisions of section ten or are insured under the provisions of section ten B.

M.G.L. c. 32A, § 11A Divorced or separated spouses; continuation of insurance coverage

c. 32A, § 11A. Divorced or separated spouses; continuation of insurance coverage Section 11A. (a) In the event of the granting of a judgment absolute of divorce or of separate support to which an employee or retiree who has health insurance or coverage under a plan or contract authorized by this chapter is a party, the person who was the spouse of said employee or retiree prior to the issuance of such judgment shall be and remain eligible for benefits under said plan or contract, whether or not said judgment was entered prior to the effective date of said plan or contract, without additional premium or examination therefor, as if said judgment had not been entered; provided, however, that such eligibility shall not be required if said judgment so provides. Such eligibility shall continue through the employee's or retiree's participation in the plan or contract until the remarriage of either the employee or retiree or such spouse, or until such time as provided by said judgment, whichever is earlier. (b) In the event of the remarriage of the employee or retiree referred to in paragraph (a), the former spouse thereafter shall have the right, if so provided in said judgment, to continue to receive benefits as are available to the employee or retiree, by means of the addition of a rider to the family plan or contract or the issuance of an individual plan or contract, either of which may be at additional premium rates determined by the group insurance commission to be just and reasonably in accordance with the additional insuring risks involved. (c) The name, address, and certificate number of a person eligible for health insurance or coverage pursuant to paragraph (a) or (b), if available, shall be forwarded by the plan or contractor, whichever is applicable, to the department of public welfare within thirty days of the date when coverage of said person under said paragraph (a) or (b) is commenced. Notice of cancellation of coverage of the divorced or separated spouse of a member shall be mailed to such divorced or separated spouse at such person's last known address, together with notice of the right to reinstate coverage retroactively to the date of cancellation. Claims paid on behalf of a divorced or separated spouse or on behalf of a dependent who is not residing with the member shall be paid to the physician, hospital or other provider of covered services or to the person on whose behalf such services were performed, unless the person is a minor child. In the event the person on whose behalf such services were performed is a minor, payment shall be made to the physician, hospital or other provider of such services or to the parent or custodian with whom the child resides.

M.G.L. c. 32A, § 12 Retired teachers; life and health insurance; agreements; contributions; withholding of premiums; reimbursement of premiums and expenses; dividends; rules and regulations

c. 32A, § 12. Retired teachers; life and health insurance; agreements; contributions; withholding of premiums; reimbursement of premiums and expenses; dividends; rules and regulations Section 12. The commission shall negotiate with and purchase on such terms as it deems to be in the best interests of the commonwealth, the political subdivisions that have accepted the provisions of this section as of April 1, 2018 and teachers retired from such political subdivision who are receiving a pension, annuity or retirement allowance from the state teachers' retirement system, as provided in chapter thirty-two, a policy or policies of group life insurance in the amount of one thousand dollars and such greater amount of group life insurance and two thousand dollars of group accidental death and dismemberment insurance for teachers retired from governmental units having accepted section nine F of chapter thirty-two B, and, a policy or policies of group hospital, surgical, medical, dental and other health insurance including optional medicare extension from one or more insurance companies, savings banks or non-profit hospital, medical or dental service corporations for such retired teachers and their dependents and the surviving spouse and dependents of such retired teachers. Said policy or policies shall consist of hospital, surgical, medical and other health insurance coverage for said retired teachers, their surviving spouse and dependents which may be related to the health insurance coverages purchased by the commonwealth under the provisions of sections four, four A and ten C or the health insurance coverages purchased by counties, cities, towns and districts under the provisions of sections three and eleven C of chapter thirty-two B. The claim experience of said retired teachers, or their surviving spouses and dependents may be maintained by the commission unrelated to the claim experience applicable to the aforementioned life and health insurance coverages. The commission shall execute all agreements or contracts pertaining to said policy or policies or any amendment thereto for and on behalf and in the name of the commonwealth for a period not to exceed five years; provided, however, that the portion of the total monthly cost to be borne initially by the commonwealth shall not exceed the estimated total monthly cost for which funds have been appropriated or otherwise made available by the general court for the then current fiscal year. The commission, subject to a subsidiary rate as hereinafter provided, may change the amount of the payment to be made by the retired teacher or surviving spouse and dependents which payment shall be fifty per cent of a monthly premium determined from time to time by the commission as part of a total monthly cost for all insurance purchased by the commission under this section and the commonwealth shall contribute the remaining fifty per cent. In addition to the contribution of fifty per cent of the aforesaid premium, the commonwealth, where necessary, shall make payment in full of a subsidiary or additional rate as determined by the commission which rate may be lower or higher than the commonwealth's fifty per cent contribution of said premium. The combination of payment of premium, subsidiary or additional rate by the commonwealth will accordingly exceed fifty per cent of the total monthly cost for such insurance but in no event shall such combination of payment by the commonwealth equal the total monthly cost for all insurance purchased as aforesaid. Every agreement or contract whether original or renewal shall, in the case of all persons insured under this section who immediately prior to the effective date of such original or new agreement or contract were insured for group life and health insurance coverages under chapter thirty-two B, provide protection by continuing uninterrupted coverage without regard to the number of months such prior insurance coverages were in force. (a) Each retired teacher or insured surviving spouse to whom this section applies shall furnish the commission, in such form as it shall prescribe, such information as is necessary to insure himself or himself and his dependents under the applicable insurance coverages described herein, and shall authorize the withholding of the appropriate premium from his pension, annuity or retirement allowance by the teachers' retirement board established by chapter fifteen. Such authorization may include the withholding of any premium which may be required by the federal health insurance for the aged act to be paid by any enrollee thereof, or make direct payment to the commission as it may determine, and the commission shall transmit all such amounts to the appropriate federal agency on behalf of such enrollee in a manner prescribed by said agency. (b) With respect to any period of insurance which is in effect for a retired teacher or surviving spouse, and dependents, notwithstanding the provisions of section nineteen of chapter thirty-two or any other general or special law to the contrary, there shall be withheld from each monthly payment of pension, annuity or retirement allowance by the teachers' retirement board the appropriate premium to be paid by said teacher or surviving spouse for such insurance and the commonwealth shall make primary payment of the remaining premium together with the subsidiary or additional rate if any, subject to reimbursement as outlined in paragraph (d). (c) The teachers' retirement board shall transmit the premiums withheld as provided in paragraph (b) to the commission in accordance with the rules and regulations of the commission. (d) The commission shall determine at least annually, or sooner, the amount of premiums and subsidiary or additional rates which shall be reimbursed to the commonwealth by counties, cities, towns and districts having retired teachers, surviving spouses and dependents insured under this section. The commission shall also determine, at least annually, the portion of the commission's expense of administering these life and health insurance coverages for retired teachers and their dependents applicable to the political subdivision from which they retired. After such determinations, the commission shall certify the amounts determined, as aforesaid, to the state treasurer for assessment. The state treasurer shall issue his warrant in the manner provided by section twenty of chapter fifty-nine requiring the cities, towns and districts concerned to pay into the treasury of the commonwealth the amounts of such premium, subsidiary or additional rate and administrative expenses attributable to such cities, towns and districts. In the case of counties, the commission on or before December the fifteenth in each year shall notify the county commissioners of each county of the amount of premium, subsidiary or additional rate and the administrative expenses attributable to such county, and said amounts shall be included in the estimate of county receipts and expenses of said county; and reimbursement for said amounts shall be made to the state treasurer as prescribed by the commission. (e) Any dividend or refund accepted by the commission from the carrier or carriers as a result of the agreements or contracts negotiated under this section shall be deposited by the commission with the state treasurer as provided in section nine. The commission shall determine the amount of dividend or refund apportionable to the various counties, cities, towns and districts having retired teachers insured hereunder and, in the case of a city, town or district, shall notify the state treasurer to reduce the premium, subsidiary rate and administrative expenses attributable to each such city, town or district by the amount of dividend or refund attributable thereto. In the case of counties, the commission shall notify the county commissioners of each county of the amount of dividend or refund attributable thereto and the estimate of receipts and expenditures for the ensuing year in each such county shall be reduced by the amount of such dividend or refund. If no premium is to be payable by a county, city, town or district for the succeeding year, the commission shall certify the same to the state treasurer who shall pay over the amount of such dividend or refund to the political subdivision entitled thereto. (f) Upon the death of a retired teacher insured under this section, the surviving spouse may continue the health insurance coverage upon the payment of the appropriate premium and in a manner prescribed by the commission. (f1/2) No political subdivision may accept the provisions of this section after April 1, 2018. (g) The rules and regulations of the commission which govern the administration of this section shall not be subject to the provisions of chapter thirty A.

M.G.L. c. 32A, § 13 Approval of applications by political subdivisions for life and health insurance covering retired teachers

c. 32A, § 13. Approval of applications by political subdivisions for life and health insurance covering retired teachers Section 13. Upon receipt of application from a political subdivision of the commonwealth having accepted the provisions of section eleven E of chapter thirty-two B, the commission shall determine whether the addition of the retired teachers, including dependents and surviving spouses, of the political subdivision to the group life and health insurance coverages provided to employees under this chapter would be in the best interests of the commonwealth, the political subdivision and all insured employees with particular consideration being given to claim experience and premium costs. Upon approval by the commission, the political subdivision having been duly notified shall then comply with the procedures outlined in the rules and regulations of the commission. The commission shall secure reimbursement to the commonwealth for the governmental units' share of the premiums, subsidiary or additional rates if any, and administrative expenses in accordance with the provisions of section ten B which are hereby made applicable to this section.

M.G.L. c. 32A, § 14 Optional insurance for services of health care organizations

c. 32A, § 14. Optional insurance for services of health care organizations Section 14. The commission may enter into a contract, hereinafter described, to make available the services of a health care organization to certain eligible active and retired employees and dependents, including the surviving spouse and dependents of such active and retired employees, on a voluntary and optional basis, as it deems to be in the best interest of the commonwealth and such eligible persons as aforesaid, provided:— (1) that the total monthly premium cost to be paid by the commission is to be paid under the terms of a contract to a carrier and not paid directly to a health care organization. For purposes of this chapter such a contract shall be deemed to be a contract of insurance; (2) that the health care organization maintains fair and nondiscriminatory formulas for the payment of all vendor's services, and that such formulas result in the same relative charges to all fiscal intermediaries or carriers with whom the health care organization has an agreement; provided, however, that any difference in relative charges which may result from the application of a rate of payment approved under section five of chapter one hundred and seventy-six A shall be deemed to comply herewith. Said commission may negotiate such a contract of insurance for and on behalf and in the name of the commonwealth for such a period of time not exceeding five years as it may in its discretion, deem to be most advantageous to the commonwealth and the persons insured thereunder. All persons eligible for the insurance provided under sections four, five, six, ten B, ten C and twelve shall have the option to be insured for the services of a health care organization under this section but shall not be insured for both. For all such persons, the commonwealth shall contribute the same percent share of the total monthly premium or rate for coverage under this section as the percent share it contributes of the health insurance programs provided under sections four, five, six, ten B, ten C, and twelve; and such eligible persons having elected coverage under this section by making application as provided in section seven, shall pay the remainder premium or rate. Such payment by the insured shall be made to the commission as provided in section eight. The commission shall require under the terms and provisions of such insurance contract an accounting at least annually of the payments made to providers of services on behalf of each person so insured; and, the extent and range of health care services shall be a matter of continuing analysis and study by the commission for the purpose of maintaining a reasonable relationship between the total monthly premium cost or rate and the range of health care services provided. On or before December first in each year the commission shall establish a list of the eligible health care organizations and a schedule of services as authorized by this section and shall so notify the appropriate public authorities in the political subdivisions of the commonwealth that have accepted the provisions of section ten of chapter thirty-two B. Any dividend or its equivalent derived from insurance contracts issued pursuant to this section shall be applied as provided in section nine. The commission may promulgate rules and regulations implementing the provisions of this section and such rules and regulations shall not be subject to the provisions of chapter thirty A.

M.G.L. c. 32A, § 15 Catastrophic illness coverage; contracts; premiums; dividends; conversion; rules and regulations

c. 32A, § 15. Catastrophic illness coverage; contracts; premiums; dividends; conversion; rules and regulations Section 15. The commission may negotiate with and purchase on such terms as it deems to be in the best interest of the commonwealth and its active and retired employees and their dependents eligible under this chapter, from one or more insurance carriers authorized to sell health insurance in the commonwealth, a policy or policies providing basic and extended coverage for catastrophic illness such as cancer and other dread diseases as may be included from time to time by the commission. Such insurance shall provide basic and extended coverage including, but not limited to, ambulance services, in-patient and out-patient hospital services, blood and plasma, medicines and drugs, x-ray and other related treatments, nursing care, surgical, medical and other licensed practitioners' services, services of institutions providing rehabilitative care, or nursing or convalescent home care, and, for custodial care necessitated as a result of an illness covered under such policy or policies of insurance. The commission shall negotiate a contract that assures sound financial stability consistent with insurance risks for long-term catastrophic illnesses, and shall be for a period of time and from time to time continuously without interruption of coverage; but any such contract with a carrier may be terminated by the commission provided that reasonable advance notice is given by the commission as provided in said policy or policies of insurance. The scope of insurance coverage under this section may relate to other health insurance coverages and experience accounting as provided in appropriate sections of this chapter, in order to attain the broadest possible basis of risk and protection. Payment of premiums for catastrophic illness insurance provided in this section shall be made by the active and retired employee or surviving spouse thereof with no contribution by the commonwealth, and the method for such payments shall be as provided in sections eight, ten, ten B, ten C, eleven, twelve and fourteen, as may be applicable. Any dividend, refund or its equivalent accepted by the commission from the carrier or carriers shall be applied as provided in section nine. Any policy or policies issued pursuant to this section shall provide that on termination of employment of an employee, or of coverage if a retiree, an employee or retiree shall be entitled, subject to the requirements of the commission, to convert his catastrophic illness coverage to a nongroup type of policy. The commission may promulgate rules and regulations implementing and maintaining the provisions of this section, and such rules and regulations shall not be subject to the provisions of chapter thirty A.

M.G.L. c. 32A, § 16 Election to continue insurance coverages; notice

c. 32A, § 16. Election to continue insurance coverages; notice Section 16. (a) An employee, in addition to the right of a deferred retiree status, or, conversion of insurance coverages to a non-group policy as provided in this chapter, and upon his involuntary termination of employment due to lack of funds, lack of work, or abolition of the position, may elect to continue all or part of his insurance coverages, including group membership in a health maintenance organization, until such employee and dependents become eligible and insured under another group plan of health insurance but in no event shall such extension of coverages exceed a period of thirty-nine weeks computed from the date of termination of employment or the date to which insurance premiums have been regularly paid whichever is the later. (b) Upon determination by the employer of the termination of employment as described in this section the appointing authority, as the employer, shall notify in writing the employee of the right to elect to continue coverages under this section and a copy of such notification shall be sent to the commission at least fifteen working days prior to the date of termination of employment. (c) The involuntarily terminated insured employee and on behalf of his dependents shall, upon election to continue insurance coverages under this section, give at least thirty days written notice thereof to the employer with a copy to the commission. For premium payment and reporting purposes, the appointing authority shall comply with the administrative and accounting procedures as established by the rules and regulations of the commission. Such employee shall be responsible for making payment to the commission of the total monthly premiums or rates, with no contribution by the commonwealth. The commission shall send a written notice by regular mail of the monthly premium when due to the last known address of the terminated employee, who, upon making timely monthly payments to the commission shall be required to certify under the penalty of perjury that the employee is not eligible or insured under another group policy or plan. Failure on the part of the commission to transmit the terminated employee's premiums to the commission's insurance carrier in a timely manner shall nevertheless render the insurance carrier and the commission liable under its contracts or policies for payment of claims to the same extent as if the commission had transmitted the employee's premiums in a timely manner to the insurance carriers or plans. (d) Upon expiration of the period of the extension as provided in this section, the commission shall provide to the terminated employee and dependents conversion rights to non-group coverages to the extent that such rights had not been exercised heretofore during the latest period of employment.

M.G.L. c. 32A, § 17 Dental and vision expenses; reimbursement of employees

c. 32A, § 17. Dental and vision expenses; reimbursement of employees Section 17. The commission shall, subject to appropriation, establish a plan of benefits for certain employees which shall, subject to the procedures and conditions established by the commission, reimburse these employees for eligible dental and vision expenses up to but not exceeding two hundred dollars per year. The commission shall collect and manage the moneys transferred to it for the funding of this plan of benefits and may make any legal deposit, investment or reinvestment of these moneys and any income derived therefrom. As used in this section, ''employees'' shall mean employees who are classified as managers in the management classification and pay plans in accordance with chapter thirty, sections forty-five and forty-six, unclassified managers who have classified positions reporting to them directly or through intermediate managers or supervisors, incumbents of positions in the executive branch assigned to collective bargaining units but designated as confidential, employees and members of the general court, and retirees who had been in the service of the commonwealth. If an employee is not described in the preceding sentence, but the employee's position is subsequently changed, reorganized or reclassified so as to be covered by the previous sentence, the employee holding such position will be considered an ''employee'' for the purposes of this section as of the date of such change.

M.G.L. c. 32A, § 17A Coverage for nonprescription enteral formulas for home use

c. 32A, § 17A. Coverage for nonprescription enteral formulas for home use Section 17A. The commission shall provide to any active or retired employee of the commonwealth who is insured under the group insurance commission coverage for nonprescription enteral formulas for home use for which a physician has issued a written order and which are medically necessary for the treatment of malabsorption caused by Crohn's disease, ulcerative colitis, gastroesophageal reflux, gastrointestinal motility, chronic intestinal pseudo-obstruction, and inherited diseases of amino acids and organic acids. Coverage for inherited diseases of amino acids and organic acids shall include food products modified to be low protein in an amount not to exceed $5,000 annually for any insured individual.

M.G.L. c. 32A, § 17B Hospice services for commonwealth employees insured under group insurance commission

c. 32A, § 17B. Hospice services for commonwealth employees insured under group insurance commission Section 17B. The commission shall provide to any active or retired employee of the commonwealth, who is insured under the group insurance commission, coverage for licensed hospice services to terminally ill patients with a life expectancy of six months or less, as set forth and regulated by the provisions of section fifty-seven D of chapter one hundred and eleven and as authorized by a duly licensed physician.

M.G.L. c. 32A, § 17C Required coverage for abortion, abortion-related care, prenatal care, childbirth, and postpartum care

c. 32A, § 17C. Required coverage for abortion, abortion-related care, prenatal care, childbirth, and postpartum care [First paragraph applicable as provided by 2022, 127, Sec. 44.] Section 17C. The commission shall provide to any active or retired employee of the commonwealth who is insured under the group insurance commission coverage for abortion as defined in section 12K of chapter 112, abortion-related care, prenatal care, childbirth and postpartum care, with a minimum of forty-eight hours of in-patient care following a vaginal delivery and a minimum of ninety-six hours of in-patient care following a caesarean section for a mother and her newly born child. Any decision to shorten these minimum coverages shall be made by the attending physician in consultation with the mother. Any such decision shall be made in accordance with rules and regulations promulgated by the department of public health. Said regulations shall be relative to early discharge, defined as less than forty-eight hours for a vaginal delivery and ninety-six hours for a caesarean delivery and post-delivery care and shall include, but not be limited to, home visits, parent education, assistance and training in breast or bottle feeding and the performance of any necessary and appropriate clinical tests; provided, however, that the first home visit shall be conducted by a registered nurse, physician, or certified nurse midwife; and provided, further, that any subsequent home visit determined to be clinically necessary shall be provided by a licensed health care provider. For the purposes of this section, attending physician shall include the attending obstetrician, pediatrician, or certified nurse midwife attending the mother and newly born child. [Third and fourth paragraphs applicable as provided by 2022, 127, Sec. 44.] Coverage provided under this section for abortion or abortion-related care shall not be subject to any deductible, coinsurance, copayment or any other cost-sharing requirement; provided, however, that deductibles, coinsurance or copayments shall be required if the applicable plan is governed by the federal Internal Revenue Code and would lose its tax-exempt status as a result of the prohibition on deductibles, coinsurance or copayments for these services. Coverage for abortion or abortion-related care offered under this section shall not impose unreasonable restrictions or delays in the coverage. Benefits for an enrollee under this section shall be the same for the enrollee's covered spouse and covered dependents. Any subscriber or member who is aggrieved by a denial of benefits to be provided under this section may appeal said denial in accordance with regulations of the department of public health.

M.G.L. c. 32A, § 17D Coverage for bone marrow transplants

c. 32A, § 17D. Coverage for bone marrow transplants Section 17D. The commission shall provide to any active or retired employee of the commonwealth who is insured under the group insurance commission coverage for a bone marrow transplant for persons who have been diagnosed with breast cancer that has progressed to metastatic disease; provided, however, that said person shall meet the criteria established by the department of public health. The department of public health shall promulgate rules and regulations establishing criteria for eligibility for coverage hereunder which shall be consistent with medical research protocols reviewed and approved by the National Cancer Institute.

M.G.L. c. 32A, § 17E Scalp hair prostheses necessary due to cancer or leukemia treatment

c. 32A, § 17E. Scalp hair prostheses necessary due to cancer or leukemia treatment Section 17E. (a) For the purposes of this section, the following words shall have the following meanings: ''Prosthesis'', an artificial appliance used to replace a lost natural structure; provided, however, that prosthesis shall include, but not be limited to, artificial arms, legs, breasts, scalp hair or glass eyes. ''Scalp hair prosthesis'', an artificial substitute for scalp hair. (b) The commission shall provide to any active or retired employee of the commonwealth who is insured under the group insurance commission, if such group coverage provides for any other prosthesis, coverage for expenses for scalp hair prostheses worn for hair loss suffered as a result of the treatment of any form of cancer or leukemia; provided, however, that such coverage shall be subject to a written statement by the treating physician that the scalp hair prosthesis is medically necessary; and provided, further, that such coverage shall be subject to the same limitations and guidelines as other prostheses. Scalp hair prosthesis coverage pursuant to this section shall not exceed an amount of $350 per year.

M.G.L. c. 32A, § 17F Newborn hearing screening test; group insurance commission coverage

c. 32A, § 17F. Newborn hearing screening test; group insurance commission coverage Section 17F. The commission shall provide to any active or retired employee of the commonwealth who is insured under the group insurance commission coverage for the cost of a newborn hearing screening test to be performed before the newborn infant is discharged from the hospital or birthing center to the care of the parent or guardian or as provided by regulations of the department of public health. Nothing contained in this section shall be construed to abrogate any obligation to provide coverage for a hearing screening test or any other hearing screening test or audiological diagnostic procedure pursuant to any law or regulation of the commonwealth or of the United States or under any of the terms or provisions of any policy, contract or certification.

M.G.L. c. 32A, § 17G Items medically necessary for the diagnosis or treatment of diabetes; group insurance commission coverage

c. 32A, § 17G. Items medically necessary for the diagnosis or treatment of diabetes; group insurance commission coverage Section 17G. The commission shall provide to an active or retired employee of the commonwealth who is insured under the group insurance commission coverage for the following items if such items are within a category of benefits or services for which coverage is otherwise afforded, have been prescribed by a health care professional legally authorized to prescribe such items and if the items are medically necessary for the diagnosis or treatment of insulin-dependent, insulin-using, gestational and non-insulin-dependent diabetes: blood glucose monitors; blood glucose monitoring strips for home use; voice-synthesizers for blood glucose monitors for use by the legally blind; visual magnifying aids for use by the legally blind; urine glucose strips; ketone strips; lancets; insulin; insulin syringes; prescribed oral diabetes medications that influence blood sugar levels; laboratory tests, including glycosylated hemoglobin, or HbAlc, tests; urinary protein/microalbumin and lipid profiles; insulin pumps and insulin pump supplies; insulin pens, so-called; therapeutic/molded shoes and shoe inserts for people who have severe diabetic foot disease when the need for therapeutic shoes and inserts has been certified by the treating doctor and prescribed by a podiatrist or other qualified doctor and furnished by a podiatrist, orthotist, prosthetist or pedorthist; supplies and equipment approved by the Federal Drug Administration for the purposes for which they have been prescribed and diabetes outpatient self-management training and education, including medical nutrition therapy, when provided by a certified diabetes health care provider participating with the insurance contract or affiliated with a provider participating with the insurance contract. As used in this section, ''certified diabetes health care provider'' shall mean a licensed health care professional with expertise in diabetes, a registered dietician or a health care provider certified by the National Certification Board of Diabetes Educators as a certified diabetes educator. When coverage is provided through a nonprofit hospital service corporation or a nonprofit medical corporation, outpatient self-management training and education shall be provided by a certified diabetes health care provider participating with the hospital service plan or medical service agreement or affiliated with a provider participating with the hospital service plan or medical service agreement. When coverage is provided through a health maintenance contract, outpatient self-management training and education, including medical nutrition therapy, shall be provided by a certified diabetes health care provider participating with the health maintenance contract or affiliated with a provider participating with the health maintenance contract. Nothing in this section shall be construed to require the commission to contract with a certified diabetes health care provider who is not already under contract with the commission. The benefits provided in this section shall meet all other terms and conditions within an insurance plan. Coverage shall not be reduced or eliminated due to the requirements of this section.

M.G.L. c. 32A, § 17H Coverage for human leukocyte or histocompatibility locus antigen testing

c. 32A, § 17H. Coverage for human leukocyte or histocompatibility locus antigen testing Section 17H. The commission shall provide to any active or retired employee of the commonwealth who is insured under the group insurance commission coverage for the cost of human leukocyte antigen testing or histocompatibility locus antigen testing that is necessary to establish bone marrow transplant donor suitability. The coverage shall cover the costs of testing for A, B or DR antigens, or any combination thereof, consistent with guidelines, criteria, rules or regulations established by the department of public health pursuant to section 218 of chapter 111.

M.G.L. c. 32A, § 17I Prosthetic devices and repairs; group insurance commission coverage

c. 32A, § 17I. Prosthetic devices and repairs; group insurance commission coverage Section 17I. (a) The commission shall provide coverage for prosthetic devices and repairs to any active or retired employee of the commonwealth who is insured under the group insurance commission under the same terms and conditions that apply to other durable medical equipment covered under the policy, except as otherwise provided in this section. (b) In this section, ''prosthetic device'' shall mean an artificial limb device to replace, in whole or in part, an arm or leg. (c) Such coverage shall not impose any annual or lifetime dollar maximum on coverage for prosthetic devices other than an annual or lifetime dollar maximum that applies in the aggregate to all items and services covered under the policy. (d) Such coverage shall not apply amounts paid for prosthetic devices to any annual or lifetime dollar maximum applicable to other durable medical equipment covered under the policy other than an annual or lifetime dollar maximum that applies in the aggregate to all items and services covered under the policy. (e) Such coverage may include a reasonable coinsurance requirement for prosthetic devices and repairs, not to exceed 20 per cent of the allowable cost of the prosthetic device or repair, unless all covered benefits applying coinsurance under the plan do so at a higher amount. If the policy provides coverage for services from nonparticipating providers, the policy may include a reasonable coinsurance requirement for prosthetic devices and repairs, not to exceed 40 per cent of the allowable cost of the device or repair when obtained from a nonparticipating provider, unless all covered benefits applying coinsurance under the plan do so at a higher amount. (f) Such coverage may require prior authorization as a condition of coverage for prosthetic devices.

M.G.L. c. 32A, § 17J Coverage for children under age 18 for cleft lip and cleft palate

c. 32A, § 17J. Coverage for children under age 18 for cleft lip and cleft palate Section 17J. The commission shall provide to any active or retired employee of the commonwealth who is insured under the group insurance commission coverage for the cost of treating cleft lip and cleft palate for children under the age of 18 covered by that employee's health plan. The coverage shall include benefits for medical, dental, oral and facial surgery, surgical management and follow-up care by oral and plastic surgeons, orthodontic treatment and management, preventative and restorative dentistry to ensure good health and adequate dental structures for orthodontic treatment or prosthetic management therapy, speech therapy, audiology and nutrition services, if such services are prescribed by the treating physician or surgeon and such physician or surgeon certifies that such services are medically necessary and consequent to the treatment of the cleft lip, cleft palate or both. The coverage required by this section shall be subject to the terms and conditions applicable to other benefits. Payment for dental or orthodontic treatment not related to the management of the congenital conditions of cleft lip and cleft palate shall not be covered under this section.

M.G.L. c. 32A, § 17K Coverage for orally administered anticancer medications

c. 32A, § 17K. Coverage for orally administered anticancer medications Section 17K. Any coverage offered by the commission to an active or retired employee of the commonwealth insured under the group insurance commission 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 favorable than intravenously administered or injected cancer medications that are covered as medical benefits. An increase in patient cost sharing for anticancer medications shall not be allowed to achieve compliance with this section.

M.G.L. c. 32A, § 17L Coverage for abuse deterrent opioid drug products

c. 32A, § 17L. Coverage for abuse deterrent opioid drug products Section 17L. Any coverage offered by the commission to an active or retired employee of the commonwealth insured under the group insurance commission 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 non-abuse deterrent opioid drug products that are covered by the commission. An increase in patient cost sharing shall not be allowed to achieve compliance with this section.

M.G.L. c. 32A, § 17M Preauthorization for substance abuse treatment not to be required

c. 32A, § 17M. Preauthorization for substance abuse treatment not to be required Section 17M. 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 medically assisted therapies; intensive outpatient and partial hospitalization services; residential or inpatient services, not covered under section 17N; and medically managed intensive inpatient services, not covered under said section 17N. Any coverage offered by the commission to an active or retired employee of the commonwealth insured under the group insurance commission shall not require a member to obtain a preauthorization for substance abuse treatment if the provider is certified or licensed by the department of public health.

M.G.L. c. 32A, § 17N Coverage for medically necessary acute treatment and clinical stabilization services; preauthorization not to be required; notice to carrier of admission and initial treatment plan

c. 32A, § 17N. Coverage for medically necessary acute treatment and clinical stabilization services; preauthorization not to be required; notice to carrier of admission and initial treatment plan Section 17N. For the purposes of this section the following terms shall have the following meanings, unless the context clearly requires otherwise:— ''Acute treatment services'', 24–hour medically supervised addiction treatment for adults or adolescents provided in a medically managed or medically monitored inpatient facility, as defined by the department of public health, that provides evaluation and withdrawal management and which may include biopsychosocial assessment, individual and group counseling, psychoeducational groups and discharge planning. ''Clinical stabilization services'', 24–hour clinically managed post detoxification treatment for adults or adolescents, as defined by the department of public health, usually following acute treatment services for substance abuse, which may include intensive education and counseling regarding the nature of addiction and its consequences, relapse prevention, outreach to families and significant others and aftercare planning, for individuals beginning to engage in recovery from addiction. The commission shall provide to any active or retired employee of the commonwealth who is insured under the group insurance commission coverage for medically necessary acute treatment services and medically necessary clinical stabilization services for up to a total of 14 days and shall not require preauthorization prior to obtaining such acute treatment services or clinical stabilization services; provided that, the facility shall provide the carrier both notification of admission and the initial treatment plan within 48 hours of admission; provided further, that utilization review procedures may be in initiated on day 7; and provided further, that the commission shall provide to any active or retired employee of the commonwealth who is insured under the group insurance commission coverage for, without preauthorization, substance use disorder evaluations ordered pursuant to section 511/2 of chapter 111. Medical necessity shall be determined by the treating clinician in consultation with the patient and noted in the patient's medical record.

M.G.L. c. 32A, § 17O Coverage for medical or drug treatments to correct or repair disturbances of body composition caused by HIV associated lipodystrophy syndrome

c. 32A, § 17O. Coverage for medical or drug treatments to correct or repair disturbances of body composition caused by HIV associated lipodystrophy syndrome [Text of section added by 2016, 233, Sec. 1. See also, Section 17O as added by 2016, 454, Sec. 1, below.] Section 17O. Any coverage offered by the commission to an active or retired employee of the commonwealth insured under the group insurance commission shall provide coverage for medical or drug treatments to correct or repair disturbances of body composition caused by HIV associated lipodystrophy syndrome including, but not limited to, reconstructive surgery, such as suction assisted lipectomy, other restorative procedures and dermal injections or fillers for reversal of facial lipoatrophy syndrome. Coverage shall be subject to a statement from a treating provider that the treatment is necessary for correcting, repairing or ameliorating the effects of HIV associated lipodystrophy syndrome. The benefits in this section shall not be subject to any greater deductible, coinsurance, copayments or out-of-pocket limits than any other benefit provided by the commission. Chapter 32A: Section 17O. Coverage for refills of prescription eye drops [Text of section added by 2016, 454, Sec. 1. See also, Section 17O added by 2016, 233, Sec. 1, above.] Section 17O. Coverage offered by the commission to an active or retired employee of the commonwealth insured through the group insurance commission that provides coverage for prescription eye drops shall provide coverage for refills of prescription eye drops in accordance with the Medicare Part D guidelines on early refills of topical ophthalmic products when: (i) the prescribing health care practitioner indicates on the original prescription that additional quantities of the prescription eye drops are needed; (ii) the refill requested by the insured does not exceed the number of additional quantities indicated on the original prescription by the prescribing health care practitioner; and (iii) the prescription eye drops prescribed by the health care practitioner are a covered benefit under the policy or contract of the insured.

M.G.L. c. 32A, § 17P Filling of remaining portion of prescription for covered drug that is a narcotic substance earlier filled in lesser quantity

c. 32A, § 17P. Filling of remaining portion of prescription for covered drug that is a narcotic substance earlier filled in lesser quantity Section 17P. The commission shall provide, to an active or retired employee of the commonwealth who is insured under the group insurance commission, for any covered drug that is a narcotic substance contained in schedule II pursuant to chapter 94C and subject to cost sharing, that if a person receives a prescription filled in a lesser quantity pursuant to section 18 of said chapter 94C, that person shall not be subject to an additional payment obligation, including but not limited to co-payments, if that person fills the remaining portion of the prescription.

M.G.L. c. 32A, § 17Q Pain management access plan; non-medication and nonsurgical treatment; review; educational materials

c. 32A, § 17Q. Pain management access plan; non-medication and nonsurgical treatment; review; educational materials [ Text of section effective for all contracts entered into, renewed or amended on or after July 1, 2025. See 2024, 285, Sec. 47.] Section 17Q. (a) The commission shall develop a plan to provide active or retired employees insured under the group insurance commission adequate coverage and access to a broad spectrum of pain management services, including, but not limited to, non-medication, nonsurgical treatment modalities and non-opioid medication treatment options that serve as alternatives to opioid prescribing, in accordance with guidelines developed by the division of insurance. (b) No such coverage offered by the commission shall, relative to pain management services identified by the commission pursuant to subsection (a), require a member to obtain prior authorization for non-medication, nonsurgical treatment modalities that include restorative therapies, behavioral health approaches or integrative health therapies, including acupuncture, chiropractic treatments, massage and movement therapies. (c)(1) The plan developed pursuant to subsection (a) shall be subject to review by the division of insurance. In its review, the division shall consider the adequacy of access to a broad spectrum of pain management services and any policies that may create unduly preferential coverage to prescribing opioids without other pain management modalities. (2) No coverage offered by the commission to an active or retired employee of the commonwealth insured under the group insurance commission shall establish utilization controls, including prior authorization or step therapy requirements, for clinically appropriate non-opioid drugs approved by the United States Food and Drug Administration for the treatment or management of pain that are more restrictive or extensive than the least restrictive or extensive utilization controls applicable to any clinically appropriate opioid drug. (d) The commission shall annually distribute educational materials to providers within their network and to members about the pain management access plan developed pursuant to subsection (a) and shall make information about the plan publicly available on its website.

M.G.L. c. 32A, § 17R Coverage for treatment of pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections and pediatric acute-onset neuropsychiatric syndrome

c. 32A, § 17R. Coverage for treatment of pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections and pediatric acute-onset neuropsychiatric syndrome [Text of section effective as applied to contracts that take effect or are renewed on or after January 1, 2022. See 2020, 260, Sec. 74.] Section 17R. The commission shall provide to any active or retired employee of the commonwealth who is insured under the group insurance commission coverage for treatment of pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections and pediatric acute-onset neuropsychiatric syndrome, including, but not limited to, the use of intravenous immunoglobulin therapy.

M.G.L. c. 32A, § 17S Coverage for medically necessary mental health acute treatment, community-based acute treatment and intensive community-based acute treatment

c. 32A, § 17S. Coverage for medically necessary mental health acute treatment, community-based acute treatment and intensive community-based acute treatment Section 17S. (a) For the purposes of this section, the following terms shall have the following meanings unless the context clearly requires otherwise:- ''Community-based acute treatment'', 24–hour clinically managed mental health diversionary or step-down services for children and adolescents that is usually provided as an alternative to mental health acute treatment. ''Intensive community-based acute treatment'', intensive 24–hour clinically managed mental health diversionary or step-down services for children and adolescents that is usually provided as an alternative to mental health acute treatment. ''Mental health acute treatment'', 24–hour medically supervised mental health services provided in an inpatient facility, licensed by the department of mental health, that provides psychiatric evaluation, management, treatment and discharge planning in a structured treatment milieu. (b) The commission shall provide to any active or retired employee of the commonwealth who is insured under the group insurance commission coverage for medically necessary mental health acute treatment, community-based acute treatment and intensive community-based acute treatment and shall not require a preauthorization before obtaining treatment; provided, however, that the facility shall notify the carrier of the admission and the initial treatment plan not more than 72 hours after admission. (c) Benefits for an employee under this section shall be the same for the employee's covered spouse and covered dependents.

M.G.L. c. 32A, § 17T Coverage for standard fertility preservation services

c. 32A, § 17T. Coverage for standard fertility preservation services Section 17T. (a) For the purposes of this section, the following words shall have the following meanings unless the context clearly requires otherwise: ''Directly or indirectly cause impairment of fertility'', to cause circumstances where a disease or the necessary treatment for a disease has a likely side effect of infertility as established by the American Society for Reproductive Medicine, the American Society of Clinical Oncology or other reputable professional organizations. ''Standard fertility preservation services'', procedures or treatments to preserve fertility as recommended by a board-certified obstetrician gynecologist, reproductive endocrinologist or other physician; provided, however, that the recommendation shall be made in accordance with current medical practices and professional guidelines published by the American Society for Reproductive Medicine, the American Society of Clinical Oncology or other reputable professional organizations. (b) The commission shall provide to any active or retired employee of the commonwealth who is insured under the group insurance commission coverage for standard fertility preservation services, including, but not limited to, coverage for procurement, cryopreservation and storage of gametes, embryos or other reproductive tissue, when the enrollee has a diagnosed medical or genetic condition that may directly or indirectly cause impairment of fertility by affecting reproductive organs or processes. Coverage shall be provided to the same extent that coverage is provided for other pregnancy-related procedures.

M.G.L. c. 32A, § 17U Coverage for postpartum depression and major depressive disorder screenings conducted pursuant to section 247 of chapter 111

c. 32A, § 17U. Coverage for postpartum depression and major depressive disorder screenings conducted pursuant to section 247 of chapter 111 Section 17U. The commission shall provide to any active or retired employee of the commonwealth who is insured under the group insurance commission coverage for postpartum depression and major depressive disorder screenings conducted pursuant to section 247 of chapter 111.

M.G.L. c. 32A, § 17V Coverage for the provision of medically necessary pasteurized donor human milk and donor human milk-derived products

c. 32A, § 17V. Coverage for the provision of medically necessary pasteurized donor human milk and donor human milk-derived products Section 17V. (a) The commission shall provide to any active or retired employee of the commonwealth who is insured under the group insurance commission coverage for the provision of medically necessary pasteurized donor human milk and donor human milk-derived products; provided, however, that: (i) the milk is obtained from a human milk bank that meets quality guidelines established by the department of public health; (ii) a licensed medical practitioner has issued a written order for the provision of such human breast milk or donor human milk-derived products for the covered infant; and (iii) the covered infant is: (1) under the age of 6 months; (2) undergoing treatment in an inpatient setting for a congenital or acquired condition that places the infant at a high risk for development of necrotizing enterocolitis or a congenital or acquired condition that may benefit from the use of such human breast milk as determined by the department of public health; and (3) medically or physically unable to receive maternal breast milk or participate in breastfeeding or whose mother is medically or physically unable, despite receiving lactation support, to produce maternal breast milk in sufficient quantities or caloric density. (b) If an inpatient stay is reimbursed through a diagnosis related group or other bundled payment arrangement, the commission shall include the cost of reimbursement provided under subsection (a) for donor human milk and donor human milk-derived products in the development of the reimbursement rate for such diagnosis related group or bundled payment.

M.G.L. c. 32A, § 17W Coverage for universal postpartum home visiting services in accordance with operational standards set by the department of public health pursuant to section 248 of chapter 111

c. 32A, § 17W. Coverage for universal postpartum home visiting services in accordance with operational standards set by the department of public health pursuant to section 248 of chapter 111 Section 17W. The commission shall provide to any active or retired employee of the commonwealth who is insured under the group insurance commission coverage for universal postpartum home visiting services in accordance with operational standards set by the department of public health pursuant to section 248 of chapter 111. Such coverage shall not be subject to cost-sharing, including co-payments and co-insurance, and shall not be subject to any deductible; provided, however, that cost-sharing shall be required if the applicable plan is governed by the Internal Revenue Code and would lose its tax-exempt status as a result of the prohibition on cost-sharing for this service.

M.G.L. c. 32A, § 17X Coverage for prescribed, ordered or dispensed opioid antagonists; reimbursement

c. 32A, § 17X. Coverage for prescribed, ordered or dispensed opioid antagonists; reimbursement Section 17X. (a) Coverage offered by the commission to an active or retired employee of the commonwealth insured under the group insurance commission shall provide coverage for prescribed, ordered or dispensed opioid antagonists, as defined in section 19B of chapter 94C and used in the reversal of overdoses caused by opioids; provided, however, that the coverage for such prescribed, ordered or dispensed opioid antagonists shall not require prior authorization; and provided further, that a prescription from a health care practitioner shall not be required for coverage or reimbursement of opioid antagonists under this section. An opioid antagonist used in the reversal of overdoses caused by opioids shall not be subject to any deductible, coinsurance, copayments or out-of-pocket limits; provided, however, that cost-sharing shall be required if the applicable plan is governed by the federal Internal Revenue Code and would lose its tax-exempt status as a result of the prohibition on cost-sharing for this service. (b) The commission shall provide coverage and reimbursement for an opioid antagonist used in the reversal of overdoses caused by opioids as a medical benefit when dispensed by the health care facility in which the opioid antagonist was prescribed or ordered and shall provide coverage as a pharmacy benefit for an opioid antagonist used in the reversal of overdoses caused by opioids dispensed by a pharmacist, including an opioid antagonist dispensed pursuant to section 19B of chapter 94C; provided, however, that the rate to be reimbursed under the medical benefit shall not exceed the commission's average in-network pharmacy benefit rate and the health care facility shall not balance bill the patient.

M.G.L. c. 32A, § 17Y Coverage for recovery coaches

c. 32A, § 17Y. Coverage for recovery coaches Section 17Y. The commission shall provide to any active or retired employee of the commonwealth who is insured under the group insurance commission coverage for the provision of services by a recovery coach licensed or otherwise authorized to practice pursuant to chapter 111J, regardless of the setting in which the services are provided; provided, however, that such services shall be within the lawful scope of practice of a recovery coach. The contractual rate for these services shall be not less than the prevailing MassHealth rate for recovery coach services. The benefits in this section shall not be subject to any deductible, coinsurance, copayments or out-of-pocket limits; provided, however, that cost-sharing shall be required if the applicable plan is governed by the federal Internal Revenue Code and would lose its tax-exempt status as a result of the prohibition on cost-sharing for the service. Recovery coach services shall not require prior authorization.

M.G.L. c. 32A, § 17Z Coverage for identified generic and brand name drug used to treat diabetes, asthma, and certain heart conditions

c. 32A, § 17Z. Coverage for identified generic and brand name drug used to treat diabetes, asthma, and certain heart conditions [Text of section applicable to all contracts entered into, renewed or amended on or after July 1, 2025. See 2024, 342, Sec. 39.] Section 17Z. (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. 355(c) except for: (A) any drug approved through an application submitted under section 505(b)(2) of the Federal Food, Drug, and Cosmetic Act that is pharmaceutically equivalent, as that term is defined by the United States Food and Drug Administration, to a drug approved under 21 U.S.C. 355(c); (B) an abbreviated new drug application that was approved by the United States Secretary of Health and Human Services under section 505(c) of the Federal Food, Drug, and Cosmetic Act, 21 U.S.C. 355(c), before the date of the enactment of the Drug Price Competition and Patent Term Restoration Act of 1984, Public Law 98–417, 98 Stat. 1585; or (C) an authorized generic drug as defined in 42 C.F.R. 447.502; (ii) produced or distributed pursuant to a biologics license application approved under 42 U.S.C. 262(a)(2)(C); or (iii) identified by the health benefit plan as a brand name drug based on available data resources, including Medi–Span. ''Generic drug'', a retail drug that is: (i) marketed or distributed pursuant to an abbreviated new drug application approved under 21 U.S.C. 355(j); (ii) an authorized generic drug as defined in 42 C.F.R. 447.502; (iii) a drug that entered the market before January 1, 1962 and was not originally marketed under a new drug application; or (iv) identified by the health benefit plan as a generic drug based on available data resources such as Medi–Span. (b) The commission shall identify 1 generic drug and 1 brand name drug used to treat each of the following chronic conditions: (i) diabetes; (ii) asthma; and (iii) the 2 most prevalent heart conditions among its members. (c) The commission shall identify insulin as the drug used to treat diabetes. In determining the 1 generic drug and 1 brand name drug used to treat each chronic condition, the commission shall consider whether the drug is: (i) of clear benefit and strongly supported by clinical evidence; (ii) likely to: (A) reduce hospitalizations or emergency department visits; (B) reduce future exacerbations of illness progression; or (C) improve quality of life; (iii) cost effective for the commission and its members; (iv) at low risk for overutilization, abuse, addiction, diversion or fraud; and (v) one of the most widely utilized as a treatment for the chronic condition. (d) The commission shall provide coverage for the brand name drugs and generic drugs identified pursuant to subsection (b). Coverage for the identified generic drugs shall not be subject to any cost-sharing, including co-payments and co-insurance, and shall not be subject to any deductible; provided, however, that cost-sharing shall be required if the applicable plan is governed by the Internal Revenue Code and would lose its tax-exempt status as a result of the prohibition on cost-sharing under this section. Coverage for the identified brand name drugs shall not be subject to any deductible or co-insurance and any co-payment shall not exceed $25 per 30–day supply. Coverage for 1 brand name insulin drug per dosage and type, including rapid-acting, short-acting, intermediate-acting, long-acting, ultra long-acting and premixed under this section shall not be subject to any deductible or co-insurance and any co-payment shall not exceed $25 per 30–day supply. (e) The commission shall implement a continuity of coverage policy to apply to members that are new to the commission and that provides coverage for a 30–day fill of a United States Food and Drug Administration-approved drug reimbursed through a pharmacy benefit that the member has already been prescribed and on which the member is stable, upon documentation by the member's prescriber; provided, however, that the commission shall not apply any greater deductible, coinsurance, copayments or out-of-pocket limits than would otherwise apply to other drugs covered by the plan. (f) The commission may make changes in its selection of drugs pursuant to this section not more than annually. (g) The commission shall make public the drugs selected pursuant to subsection (b).

M.G.L. c. 32A, § 18 Medicare health benefits supplement plan, mandatory transfer; payment of penalty

c. 32A, § 18. Medicare health benefits supplement plan, mandatory transfer; payment of penalty Section 18. Notwithstanding any other provision of this chapter, all retirees, their spouses and dependents insured or eligible to be insured under sections five, ten B and twelve, if enrolled in medicare part A at no cost to the retiree, spouse or dependents, or eligible for coverage thereunder at no cost to the retiree, spouse or dependents, shall be required to transfer to a medicare health benefits supplement plan offered by the commission under section ten C or section fourteen; provided, that benefits under said plan and medicare part A and part B together shall be of comparable actuarial value to those under the retiree's existing coverage. Each retiree shall provide the commission, in such form as the commission shall prescribe, such information as is necessary to transfer to a medicare health benefits supplement plan. If a retiree does not submit the information required, he shall no longer be eligible for his existing health coverage. The commonwealth shall pay any medicare part B premium penalty assessed by the federal government on said retirees, spouses and dependents as a result of enrollment in medicare part B at the time of transfer into the medicare health benefits supplement plan.

M.G.L. c. 32A, § 19 Release from insurance coverage; payment; reinstatement of coverage

c. 32A, § 19. Release from insurance coverage; payment; reinstatement of coverage Section 19. Effective January 1 and July 1 of each year, the commission may pay to any active or retired employee of the commonwealth who has been continuously insured by the commonwealth for the prior 6 months pursuant to the provisions of this chapter for hospital, surgical, medical or other health insurance benefits and who gives written notice in accordance with the provisions of section seven indicating his desire not to be so insured by the commonwealth, an amount of money to be determined by the secretary of administration and finance; provided that such amount shall equal no less than twenty-five percent of twelve times the total monthly rate in effect for individual insurance coverage as determined by the commission; provided further, that the commission shall pay such amount to such active or retired employee in payments or in one lump sum. The commission shall require that any active or retired employee choosing to accept such payment shall verify that he is insured under a qualifying policy toward which the commonwealth makes no contribution; provided, that for the purpose of this section, a ''qualifying policy'' shall be any policy which provides a schedule of benefits comparable to that to which the employee would be eligible to receive if he were insured by the commonwealth under this chapter. The commission shall provide that if such active or retired employee ceases to be so insured under such a qualifying policy, such active or retired employee shall thereupon have his insurance coverage pursuant to this chapter reinstated by the commonwealth on the date on which he informs the commission of such termination of insurance coverages; provided, however, that any amounts to be paid to such active or retired employee in accordance with this section shall be ratably reduced and any amounts paid hereunder which are allocable to periods after insurance coverage pursuant to this chapter is reinstated by the commonwealth may be recovered by the commission under such terms and conditions as the commission shall determine.

M.G.L. c. 32A, § 20 Charges or collections of excess compensation

c. 32A, § 20. Charges or collections of excess compensation Section 20. No physician or other provider of services, who treats or provides services to an individual covered by hospital, surgical, medical or catastrophic illness coverage offered by the commission under section four, four A, ten B, twelve or fifteen, shall charge to or collect from any insured or other beneficiary any amount in excess of that amount of compensation determined or allowed for a particular service by the insurer or by the administrator. For purposes of this section the words insurer and administrator shall include any insurance carrier, nonprofit hospital or medical service corporation or third-party health care administrator operating within the scope of its license. Nothing in this section shall be construed to prevent the collection of any copayments or deductibles allowed for in the plan design.

M.G.L. c. 32A, § 21 Health care services evaluation; vendor quality improvement program; annual report

c. 32A, § 21. Health care services evaluation; vendor quality improvement program; annual report Section 21. The commission is hereby authorized and directed to establish and implement a vendor quality improvement program for purposes including, but not limited to: the evaluation and improvement of all health care services as applied to those contracts and the promotion of customer-oriented quality management techniques. Such program shall include both long and short-term objectives, quantifiable improvement goals, benchmarks for evaluating vendors and mechanisms to promote collaboration between the commission and health care vendors to improve health care services. The commission shall file an annual report with the clerks of the senate and house of representatives and with the governor not later than September 30 concerning such vendor quality improvement program.

M.G.L. c. 32A, § 22 Diagnosis and treatment of certain biologically-based mental disorders; mental disorders of victims of rape; non-biologically-based mental disorders of children and adolescents under age 19; group insurance commission coverage

c. 32A, § 22. Diagnosis and treatment of certain biologically-based mental disorders; mental disorders of victims of rape; non-biologically-based mental disorders of children and adolescents under age 19; group insurance commission coverage Section 22. (a) The commission shall provide to any active or retired employee of the commonwealth who is insured under the group insurance commission coverage on a nondiscriminatory basis for the diagnosis and treatment of the following biologically-based mental disorders, as described in the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders published by the American Psychiatric Association, referred to in this section as the DSM: (1) schizophrenia; (2) schizoaffective disorder; (3) major depressive disorder; (4) bipolar disorder; (5) paranoia and other psychotic disorders; (6) obsessive-compulsive disorder; (7) panic disorder; (8) delirium and dementia; (9) affective disorders; (10) eating disorders; (11) post traumatic stress disorders; (12) substance abuse disorders; and (13) autism. The commission shall also provide to any active and retired employee of the commonwealth who is insured under the group insurance commission coverage on a nondiscriminatory basis for the diagnosis and medically necessary and active treatment of any mental disorder, as described in the most recent edition of the DSM, that is approved by the commissioner of mental health. (b) In addition to the coverage established pursuant to this section, any health plan offered by the commission shall also provide coverage on a non-discriminatory basis for the diagnosis and treatment of rape-related mental or emotional disorders to victims of a rape or victims of an assault with intent to commit rape, as defined by sections 22 and 24 of chapter 265, whenever the costs of such diagnosis and treatment exceed the maximum compensation awarded to such victims pursuant to subparagraph (C) of paragraph (2) of subsection (b) of section 3 of chapter 258C. (c) In addition to the coverage established pursuant to this section, any such health plan shall also provide coverage on a non-discriminatory basis for children and adolescents under the age of 19 for the diagnosis and treatment of non-biologically-based mental, behavioral or emotional disorders described in the most recent edition of the DSM which substantially interfere with or substantially limit the functioning and social interactions of such a child or adolescent; provided, that said interference or limitation is documented by and the referral for said diagnosis and treatment is made by the primary care provider, primary pediatrician, or a licensed mental health professional of such a child or adolescent or is evidenced by conduct, including, but not limited to: (1) an inability to attend school as a result of such a disorder, (2) the need to hospitalize the child or adolescent as a result of such a disorder, or (3) a pattern of conduct or behavior caused by such a disorder which poses a serious danger to self or others. Any such health plan shall continue to provide such coverage to any adolescent who is engaged in an ongoing course of treatment beyond the adolescent's nineteenth birthday until said course of treatment, as specified in said adolescent's treatment plan, is completed and while the benefit contract under which such benefits first became available remains in effect, or subject to a subsequent benefits contract which is in effect. (d) Any such health plan shall be deemed to be providing such coverage on a non-discriminatory basis if said plan does not contain any annual or lifetime dollar or unit of service limitation on coverage for the diagnosis and treatment of said mental disorders which is less than any annual or lifetime dollar or unit of service limitation imposed on coverage for the diagnosis and treatment of physical conditions. (e) The commission shall also provide medically necessary coverage for the diagnosis and treatment of all other mental disorders not otherwise provided for in this section and which are described in the most recent edition of the DSM during each 12 month period for a minimum of 60 days of inpatient treatment and for a minimum of 24 outpatient visits. [There is no subsection (f).] (g) The coverage authorized pursuant to this section shall consist of a range of inpatient, intermediate, and outpatient services that shall permit medically necessary and active and noncustodial treatment for said mental disorders to take place in the least restrictive clinically appropriate setting. For purposes of this section, inpatient services may be provided in a general hospital licensed to provide such services, in a facility under the direction and supervision of the department of mental health, in a private mental hospital licensed by the department of mental health, or in a substance abuse facility licensed by the department of public health. Intermediate services shall include, but not be limited to, Level III community-based detoxification, acute residential treatment, partial hospitalization, day treatment and crisis stabilization licensed or approved by the department of public health or the department of mental health. Outpatient services may be provided in a licensed hospital, a mental health or substance abuse clinic licensed by the department of public health, a public community mental health center, a professional office, or home-based services, provided, however, services delivered in such offices or settings are rendered by a licensed mental health professional acting within the scope of his license. (h) The commission may, as a condition of providing coverage pursuant to this section, require consent to the disclosure of information regarding services for mental disorders only to the same or similar extent in which it requires consent for the disclosure of information for other medical conditions. Only licensed mental health professionals shall be allowed to deny services mandated by this section. The provisions of this subsection shall not be construed as applying to denials of service resulting from an insured's lack of insurance coverage or the use of a facility or professional which, if applicable, has not entered into a negotiated agreement with a health plan. The benefits provided in any insurance plan pursuant to this section shall meet all other terms and conditions of the plan not inconsistent with this section. (i) Nothing in this section shall be construed to require the commission to pay for mental health benefits or services: which are provided to a person who has third party insurance and who is presently incarcerated, confined or committed to a jail, house of correction or prison, or custodial facility in the department of youth services within the commonwealth or one of its political subdivisions; which constitute educational services required to be provided by a school committee pursuant to section 5 of chapter 71B; or which constitute services provided by the department of mental health. For the purposes of this section, ''licensed mental health professional'' shall mean a licensed physician who specializes in the practice of psychiatry, a licensed psychologist, a licensed independent clinical social worker, a licensed mental health counselor, a licensed nurse mental health clinical specialist, a licensed alcohol and drug counselor I, as defined in section 1 of chapter 111J, or a licensed marriage and family therapist within the lawful scope of practice for such therapist.

M.G.L. c. 32A, § 22A Coverage for mental health or substance use disorder services delivered through the psychiatric collaborative care model

c. 32A, § 22A. Coverage for mental health or substance use disorder services delivered through the psychiatric collaborative care model Section 22A. (a) For the purposes of this section, ''psychiatric collaborative care model'' shall mean the evidence-based, integrated behavioral health service delivery method in which a primary care team consisting of a primary care provider and a care manager provides structured care management to a patient, and that works in collaboration with a psychiatric consultant that provides regular consultations to the primary care team to review the clinical status and care of patients and to make recommendations. (b) The commission shall provide to any active or retired employee of the commonwealth who is insured under the group insurance commission coverage for mental health or substance use disorder services that are delivered through the psychiatric collaborative care model.

M.G.L. c. 32A, § 22B Implement and enforcement of mental health parity provisions of the federal Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008; federal guidance and regulations and state mental health parity laws and regulations; annual report

c. 32A, § 22B. Implement and enforcement of mental health parity provisions of the federal Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008; federal guidance and regulations and state mental health parity laws and regulations; annual report Section 22B. (a) The commission shall implement and enforce the mental health parity provisions of the federal Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008, 42 U.S.C. 300gg–26, as amended, federal guidance or regulations issued under the act, applicable state mental health parity laws and regulations and, to the degree applicable to its health benefit plans, guidance issued by the commissioner of insurance under section 8K of chapter 26 by: (i) utilizing the commission's procurement, contracting, vendor oversight and auditing authority to ensure that the commission's health benefit plans that provide medical and surgical benefits and mental health and substance use disorder benefits are compliant with the applicable state or federal laws related to mental health and substance use disorder parity; (ii) performing audits of each of the commission's health benefit plans at least once every 4 years, or more frequently if noncompliance is suspected, with a focus on: (A) nonquantitative treatment limitations under the federal Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008, as amended, and applicable state mental health and substance use disorder parity laws, including, but not limited to, prior authorization, concurrent review, retrospective review, step-therapy, network admission standards, reimbursement rates, network adequacy and geographic restrictions; (B) denials of authorization, payment and coverage; and (C) any other criteria determined by the commission, including factors identified through consumer or provider complaints; (iii) requiring the commission's health benefit plans that provide medical and surgical benefits and mental health and substance use disorder benefits to comply with the annual reporting requirements under subsection (b); and (iv) evaluating all consumer or provider complaints regarding mental health and substance use disorder coverage for possible parity violations not more than 3 months after receipt. (b) The commission's health benefit plans that provide medical and surgical benefits and mental health and substance use disorder benefits shall submit an annual report not later than July 1 to the commission that contains: (i) the specific plan or coverage terms or other relevant terms regarding the nonquantitative treatment limitations and a description of all mental health and substance use disorder benefits and medical and surgical benefits to which each term applies in each respective benefits classification; provided, however, that the nonquantitative treatment limitations shall include the processes, strategies, evidentiary standards or other factors used to develop and apply the health benefit plan's reimbursement rates for mental health and substance use disorder benefits and medical and surgical benefits in each respective benefits classification; (ii) the factors used to determine that the nonquantitative treatment limitations will apply to mental health and substance use disorder benefits and medical and surgical benefits; (iii) the evidentiary standards used for the factors identified in clause (ii), when applicable; provided, that every factor shall be defined, and any other source or evidence relied upon to design and apply the nonquantitative treatment limitations to mental health and substance use disorder benefits and medical and surgical benefits; (iv) a comparative analysis demonstrating that the processes, strategies, evidentiary standards and other factors used to apply the nonquantitative treatment limitations to mental health and substance use disorder benefits, as written and in operation, are comparable to, and are applied no more stringently than, the processes, strategies, evidentiary standards and other factors used to apply the nonquantitative treatment limitations to medical or surgical benefits in the benefits classification; (v) the specific findings and conclusions reached by the health benefit plan with respect to health insurance coverage, including any results of the analysis described in clause (iv) that indicate whether the health benefit plan is in compliance with this section and the federal Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008, as amended, and any federal guidance or regulations relevant to the act; and (vi) any other data or information the commission deems necessary to assess a health benefit plan's compliance with state or federal laws related to mental health and substance use disorder parity. (c) If federal guidance, including, but not limited to, the Self-Compliance Tool for the federal Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008, as amended, is released that indicates a nonquantitative treatment limitation analysis process and reporting format that is significantly different from, contrary to or more efficient than the nonquantitative treatment limitation analysis process and reporting format requirements described in subsection (b), the commission may revise the analysis and reporting requirements described in said subsection (b). (d) Any proprietary portions of information submitted to the commission by a health benefit plan as a result of the requirements of this section shall not be a public record under clause Twenty-sixth of section 7 of chapter 4 or chapter 66; provided, however, that the commission may produce reports summarizing any findings. (e) Annually, not later than December 1, the commission shall submit a summary of the reports that the commission receives from all health benefit plans under subsection (b) to the clerks of the senate and house of representatives, the joint committee on mental health, substance use and recovery and the joint committee on health care financing. The summary report shall include, but not be limited to: (i) the methodology the commission is using to check for compliance with the federal Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008, as amended, and any federal guidance or regulations relevant to the act; (ii) the methodology the commission is using to check for compliance with applicable state mental health parity laws and regulations, including section 22 of chapter 32A, and, to the degree applicable to its health benefit plans, guidance issued by the commissioner of insurance under section 8K of chapter 26; (iii) a summary of any audit findings for audits conducted and completed under clause (ii) of subsection (a) during the immediately preceding calendar year regarding access to behavioral health services or compliance with parity in mental health and substance use disorder benefits under state and federal laws and any actions taken as a result of such audit; and (iv) the number of consumer complaints the commission has received in the immediately preceding calendar year regarding access to behavioral health services or compliance with parity in mental health and substance use disorder benefits under state and federal laws and a summary of all complaints resolved by the commission during that time period. The summary report shall be written in nontechnical, readily understandable language and made available to the public by posting the report on the commission's website.

M.G.L. c. 32A, § 23 Coverage for speech, hearing and language disorders

c. 32A, § 23. Coverage for speech, hearing and language disorders Section 23. The commission shall provide to any active or retired employee of the commonwealth who is insured under the commission coverage for expenses incurred in the medically necessary diagnosis and treatment of speech, hearing and language disorders by individuals licensed as speech-language pathologists or audiologists under chapter 112, if such services are rendered within the lawful scope of practice for such speech-language pathologists or audiologists regardless of whether the services are provided in a hospital, clinic or private office; provided, however, that such coverage shall not extend to the diagnosis or treatment of speech, hearing and language disorders in a school-based setting. The coverage provided by this section shall be subject to the same terms and conditions established for any other medical condition covered by the commission. The commission shall provide to any child, who is 21 years of age or younger, of an active or retired employee of the commonwealth and who is insured under the group insurance commission coverage for the cost of 1 hearing aid per hearing-impaired ear up to $2,000 for each hearing aid, as defined in section 196 of chapter 112, every 36 months upon a written statement from the child's treating physician that the hearing aids are necessary regardless of etiology. Coverage under this section shall include all related services prescribed by a licensed audiologist or hearing instrument specialist, as defined in said section 196 of said chapter 112, including the initial hearing aid evaluation, fitting and adjustments and supplies, including ear molds. The insured may choose a higher priced hearing aid and may pay the difference in cost above the $2,000 limit in this section without any financial or contractual penalty to the insured or to the provider of the hearing aid. The benefits in this section shall not be subject to any greater deductible, coinsurance, copayments or out-of-pocket limits than other benefits provided by the insurer. Nothing in this section shall prohibit the commission from offering greater coverage for hearing aids than required by this section. This section shall also require coverage for such hearing aids under any non-group policy.

M.G.L. c. 32A, § 24 State Retiree Benefits Trust Fund

c. 32A, § 24. State Retiree Benefits Trust Fund Section 24. (a) There shall be established and set up on the books of the commonwealth a fund to be known as the State Retiree Benefits Trust Fund. The State Retiree Benefits Trust Fund board of trustees established in section 24A shall be the trustee of the fund and shall employ the pension reserves investment management board to invest the fund's assets in the Pension Reserves Investment Trust Fund. The fund shall be an expendable trust not subject to appropriation. (b) The purpose of said fund shall be for depositing, investing and disbursing amounts set aside solely to meet liabilities of the state employees' retirement system for health care and other non-pension benefits for retired members of the system and for depositing, investing and disbursing amounts transferred to it under subsection (d). There shall be credited to the fund any revenue from appropriations or other monies authorized by the general court and specifically designated to be credited to the fund, and any gifts, grants, private contributions, investment income earned on the fund's assets and all other sources. Money remaining in the fund at the end of a fiscal year shall not revert to the General Fund. (c) Upon request of the group insurance commission established, the board may expend amounts in the fund, without further appropriation, to pay the costs of health care and other non-pension benefits for retired members of the state retirement system; provided, however, that said group insurance commission shall remain responsible for administering the payment of, and determining the terms, conditions, schedule of benefits, carriers and eligibility for, health care and other non-pension benefits for retired members of the state retirement system. (d) Upon authorization by the board, any political subdivision, municipality, county or agency or authority of the commonwealth may participate in the fund using procedures and criteria to be adopted by the board. (e) The fund shall be revocable only when all such health care and other non-pension benefits, current and future, payable pursuant to this chapter have been paid or defeased. (f) The trustees shall adopt an annual budget for the fund and supplemental budgets that the trustees consider necessary, subject to the approval of the general court. Funding for the budget shall be from the investment return of the fund. If the general court takes no final action to disapprove a budget within 60 days after its filing with the clerk of the house of representatives and the clerk of the senate, the budget shall be considered to be approved. If the general court disapproves a budget within 60 days after it has been filed, the trustees shall operate under the annualized budgetary level most recently approved pending the filing and subsequent approval of any other annual or supplemental budget request. (g) The trustees shall engage actuaries experienced in retiree health care costs to perform annual actuarial calculations in accordance with Government Accounting Standards Board Statements 43 and 45, using data as needed from the group insurance commission, the public employee retirement administration commission, the state treasurer and the comptroller and prepare funding schedules to be filed in accordance with section 25. (h) The trustees shall engage an independent auditor to perform an annual audit of the State Retiree Benefits Trust Fund's assets, liabilities, net assets, investments and operations on an annual basis in accordance with government auditing standards and policies established by the comptroller. The annual audit report shall be made available to all participating subdivisions, authorities, boards or instrumentalities not later than September 15. (i) All transactions affecting the fund including, but not limited to, all amounts credited to and all expenditures, transfers or allocations made from the fund shall be recorded by a subsidiary on the Massachusetts management accounting and reporting system. (j) The fund shall be classified by the comptroller as a nonbudgeted fund of the commonwealth. Amounts credited to the fund, including both principal and earnings, shall not be subject to the calculation of the consolidated net surplus under sections 2H and 5C of chapter 29. (k) The attorney general shall file a quarterly report with the state comptroller, the secretary of administration and finance and the house and senate committees on ways and means which shall include, but not be limited to: (i) an updated schedule of payments due to the commonwealth under the master settlement agreement in Commonwealth of Massachusetts v. Philip Morris, Inc. et al., Middlesex Superior Court, No. 95–7378; (ii) an analysis of imminent factors that may affect the industry's ability to generate those payments to the commonwealth; (iii) a detailed account of the analysis and methodology used to determine the variations associated with the schedule of payments; (iv) an explanation of the financial impact that those variations in the schedule of payments shall have upon the amount due to the commonwealth and the industry's obligation to the commonwealth; and (v) an itemized account of all amendments that have been made to the master settlement agreement referenced in clause (i).

M.G.L. c. 32A, § 24A State Retiree Benefits Trust Fund board of trustees; membership; powers and duties

c. 32A, § 24A. State Retiree Benefits Trust Fund board of trustees; membership; powers and duties Section 24A. (a) The State Retiree Benefits Trust Fund shall be managed by a board of trustees which shall have general supervision of the trust. The duties and obligations of the board shall be set forth in a declaration of trust to be adopted by the board. The declaration of trust and any amendments to it shall be filed with the general court, but if the general court takes no final action on the declaration or any amendments to it within 60 days after the date of the filing of the declaration or any amendments with the clerks of the senate and house of representatives, the declaration or amendments shall be considered to be approved. (b) The board of trustees shall consist of 7 trustees, including the secretary of administration and finance or a designee, the executive director of the group insurance commission or a designee, the executive director of the public employee retirement administration commission or a designee, the state treasurer or a designee, the comptroller or a designee, 1 person to be appointed by the governor and 1 person to be appointed by the state treasurer. The appointed trustees shall serve for terms of 5 years and shall be experienced in the fields of investment, financial management, law and public management. Trustees shall be eligible for reappointment. The members of the board shall elect 1 of the trustees to serve as the chair. (c) A trustee shall disclose in advance to the board any interest or involvement in any matter that is before the board. The disclosure shall be contemporaneously recorded in the minutes of the board. A trustee having such an interest or involvement shall not participate in any such matter. (d) The board may select an executive director who shall serve at the pleasure of the board. Sections 9A, 45, 46 and 46C of chapter 30, chapter 31 and chapter 150E shall not apply to the executive director or any other employees of the board. The executive director shall, with the approval of the board: (i) plan, direct, coordinate and execute administrative and investment functions in conformity with the policies and directives of the board; (ii) employ professional and clerical staff as necessary; (iii) report to the board on all operations under the director's control and supervision; (iv) prepare an annual budget and manage the administrative expenses of the trust; and (v) undertake any other activities necessary to implement the powers and duties set forth in this section. If the board does not select an executive director, the chair shall perform all the duties and functions of the executive director set forth in this section or, with the approval of the board, the chair may delegate duties to others. (e) In addition to the other powers and duties set forth in this section, the board shall approve or ratify decisions of the executive director or, if the board does not select an executive director, the chair or other person designated to carry out the powers and duties of an executive director, formulate policies and procedures considered necessary and appropriate to carry out the purposes of the fund, maintain a record of its proceedings and undertake any other activities necessary to implement the powers and duties set forth in this section. (f) All records of the fund, including the transactions of the fund, shall be public records as defined in clause Twenty-sixth of section 7 of chapter 4. (g) In a civil action brought against a trustee or employee of the fund, acting within the scope of the official duties of the trustee or employee, the defense or settlement of which is made by the attorney general or by an attorney employed by the board, the trustee or employee shall be indemnified for all expenses incurred in the defense of the action and shall be indemnified for damages to the same extent as provided for public employees in chapter 258. No trustee or employee shall be indemnified for expenses in an action or damages awarded in an action in which there was shown to be a breach of fiduciary duty, an act of willful dishonesty or an intentional violation of law by the trustee or employee.

M.G.L. c. 32A, § 25 Insurance coverage for diagnosis and treatment of autism spectrum disorder

c. 32A, § 25. Insurance coverage for diagnosis and treatment of autism spectrum disorder Section 25. (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 rendering an actuarial opinion related to health insurance rate making. ''Applied behavior analysis'', the design, implementation and evaluation of environmental modifications, using behavioral stimuli and consequences, to produce socially significant improvement in human behavior, including the use of direct observation, measurement and functional analysis of the relationship between environment and behavior. ''Autism services provider'', a person, entity or group that provides treatment of autism spectrum disorders. ''Autism spectrum disorders'', any of the pervasive developmental disorders as defined by the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders, including autistic disorder, Asperger's disorder and pervasive developmental disorders not otherwise specified. ''Board certified behavior analyst'', a behavior analyst credentialed by the behavior analyst certification board as a board certified behavior analyst. ''Diagnosis of autism spectrum disorders'', medically necessary assessments, evaluations including neuropsychological evaluations, genetic testing or other tests to diagnose whether an individual has 1 of the autism spectrum disorders. ''Habilitative or rehabilitative care'', professional, counseling and guidance services and treatment programs, including, but not limited to, applied behavior analysis supervised by a board certified behavior analyst, that are necessary to develop, maintain and restore, to the maximum extent practicable, the functioning of an individual. ''Pharmacy care'', medications prescribed by a licensed physician and health-related services deemed medically necessary to determine the need or effectiveness of the medications, to the same extent that pharmacy care is provided by the insurance policy for other medical conditions. ''Psychiatric care'', direct or consultative services provided by a psychiatrist licensed in the state in which the psychiatrist practices. ''Psychological care'', direct or consultative services provided by a psychologist licensed in the state in which the psychologist practices. ''Therapeutic care'', services provided by licensed or certified speech therapists, occupational therapists, physical therapists or social workers. ''Treatment of autism spectrum disorders'', includes the following care prescribed, provided or ordered for an individual diagnosed with 1 of the autism spectrum disorders by a licensed physician or a licensed psychologist who determines the care to be medically necessary: habilitative or rehabilitative care; pharmacy care; psychiatric care; psychological care; and therapeutic care. (b) The commission shall provide to an active or retired employee of the commonwealth who is insured under the group insurance commission benefits on a nondiscriminatory basis for the diagnosis and treatment of autism spectrum disorder in individuals. (c) A health plan provided by the commission shall be in compliance with subsection (b) if the plan does not contain an annual or lifetime dollar or unit of service limitation on coverage for the diagnosis and treatment of autism spectrum disorders which is less than an annual or lifetime dollar or unit of service limitation imposed on coverage for the diagnosis and treatment of physical conditions. (d) This section shall not limit benefits that are otherwise available to an individual under a health insurance policy. (e) Coverage under this section shall not be subject to a limit on the number of visits an individual may make to an autism services provider. (f) This section shall not affect an obligation to provide services to an individual under an individualized family service plan, an individualized education program or an individualized service plan. Services related to autism spectrum disorder provided by school personnel under an individualized education program are not subject to reimbursement under this section. (g) An insurer, corporation or health maintenance organization shall be exempt for a period of 3 years from the requirement to provide coverage for habilitative or rehabilitative care required under this section and not covered by the insurer, corporation or health maintenance organization as of December 31, 2010, if: (1) an actuary, affiliated with the insurer, corporation or health maintenance organization certifies in writing to the commissioner of insurance that: (i) based on an analysis to be completed not more than once annually by each insurer, corporation or health maintenance organization for the most recent experience period of at least 1 year's duration, the annual costs associated with coverage of habilitative or rehabilitative care required under this section and not covered as of December 31, 2010, exceeded 1 per cent of the premiums charged over the experience period by the insurer, corporation or health maintenance organization; (ii) those costs solely would lead to an increase in average premiums charged of more than 1 per cent for all insurance policies, subscription contracts or health care plans commencing on inception or the next renewal date, based on the premium rating methodology and practices the insurer, corporation or health maintenance organization employs; and (iii) the commissioner of insurance approves the certification of the actuary. (2) An exemption allowed under paragraph (1) shall apply for a 3 year coverage period following inception or next renewal date of all insurance policies, subscription contracts or health care plans issued or renewed during the 1–year period following the date of the exemption, after which the insurer, corporation or health maintenance organization shall again provide coverage for habilitative or rehabilitative care required under this section. (3) Notwithstanding the exemption allowed under paragraph (1), an insurer, corporation or health maintenance organization may elect to continue to provide coverage for habilitative or rehabilitative care required under this section.

M.G.L. c. 32A, § 25A Coverage for treatment of Down syndrome through speech therapy, occupational therapy, physical therapy and applied behavior analysis services

c. 32A, § 25A. Coverage for treatment of Down syndrome through speech therapy, occupational therapy, physical therapy and applied behavior analysis services [Text of section added by 2024, 388, Sec. 1 effective January 1, 2026. See 2024, 388, Sec. 7.] Section 25A. For purposes of this section, ''Down syndrome'' shall mean a chromosomal condition caused by an error in cell division that results in the presence of an extra whole or partial copy of chromosome 21. The commission shall provide to any active or retired employee of the commonwealth who is insured under the group insurance commission coverage for the treatment of Down syndrome through speech therapy, occupational therapy, physical therapy and applied behavior analysis services.

M.G.L. c. 32A, § 26 Wellness program

c. 32A, § 26. Wellness program Section 26. The commission shall, subject to appropriation, negotiate with and purchase, on such terms as it deems to be in the best interest of the commonwealth and its employees, from 1 or more entities that can manage a wellness program covering persons in the service of the commonwealth and their dependents, and shall execute all agreements or contracts pertaining to the program. The commission may negotiate a contract for such term not exceeding 5 years as it may, in its discretion, deem to be the most advantageous to the commonwealth; provided, however that the program shall be able to evaluate individual and aggregate data, give employees access to their individual information confidentially and allow the commission to receive collective reports summarizing baseline and ongoing data regarding the behavior and well being of enrollees. The commission may reduce premiums or co-payments or offer other incentives to encourage enrollees to comply with the wellness program goals. Beginning 1 year after the end of the fiscal year in which the commission has implemented the wellness program, the commission shall submit an annual report to the governor, the secretary of health and human services, the secretary of administration and finance, the chairs of the joint committee on health care financing, chairs of the house and senate committees on ways and means, the speaker of the house of representatives and the senate president. The report shall include the collective results including, but not limited to, the level of participation among employees, incentives provided for participation, the number and type of screenings and diagnostic tests conducted, the instance of undiagnosed risks defined as out of range diagnostic tests and number of employees seeking and receiving preventative treatment. The commission shall use this information in the negotiating and purchasing, on such terms as it deems in the best interest of the commonwealth and its employees, from 1 or more insurance companies, savings banks or non-profit hospital or medical service corporations, of a policy or policies of group life and accidental death and dismemberment insurance covering persons in the service of the commonwealth and group general or blanket insurance providing hospital, surgical, medical, dental and other health insurance benefits covering persons in the service of the commonwealth and their dependents. Beginning 1 year after the end of the fiscal year in which the commission has implemented the wellness program, the commission shall annually submit a report to the governor, secretary of administration and finance, the chairs of the joint committee on health care financing, the chairs of the house and senate committees on ways and means, the speaker of the house of representatives and the senate president on the savings that have been achieved in procuring such insurance policies since implementing the wellness program.

M.G.L. c. 32A, § 27 Toll-free telephone number and website providing customers with estimated or maximum allowed amount or charge for proposed admission, procedure or service

c. 32A, § 27. Toll-free telephone number and website providing customers with estimated or maximum allowed amount or charge for proposed admission, procedure or service Section 27. The commission shall require any carriers or third party administrators with whom it contracts to provide a toll-free telephone number and website that enables consumers to request and obtain from the carrier or third party administrator, in real time, the estimated or maximum allowed amount or charge for a proposed admission, procedure or service and the estimated amount the insured will be responsible to pay for a proposed admission, procedure or service that is a medically necessary covered benefit, based on the information available to the carrier or third party administrator at the time the request is made, including any facility fee, copayment, deductible, coinsurance or other out of pocket amount for any covered health care benefits; provided, that the insured shall not be required to pay more than the disclosed amounts for the covered health care benefits that were actually provided; provided, however, that nothing in this section shall prevent carriers from imposing cost sharing requirements disclosed in the insured's evidence of coverage for unforeseen services that arise out of the proposed admission, procedure or service; and provided further, that the carrier shall alert the insured that these are estimated costs, and that the actual amount the insured will be responsible to pay may vary due to unforeseen services that arise out of the proposed admission, procedure or service.

M.G.L. c. 32A, § 28 Coverage for certain services and contraceptive methods

c. 32A, § 28. Coverage for certain services and contraceptive methods Section 28. (a) Coverage offered by the commission to an active or retired employee of the commonwealth insured under the group insurance commission shall provide coverage for the following services and contraceptive methods: (i) Food and Drug Administration, FDA, approved contraceptive drugs, devices and other products; provided, however, that coverage shall not be required for male condoms or FDA-approved oral contraceptive drugs that do not have a therapeutic equivalent; and provided further, that: (A) if the FDA has approved 1 or more therapeutic equivalents of a contraceptive drug, device or product, the commission shall not be required to include all such therapeutically equivalent versions in its formulary as long as at least 1 is included and covered without cost-sharing and in accordance with this section; and (B) if there is a therapeutic equivalent of a drug, device or other product for an FDA-approved contraceptive method, the commission may provide coverage for more than 1 drug, device or other product and may impose cost-sharing requirements as long as at least 1 drug, device or other product for that method is available without cost-sharing; provided, however, that if an individual's attending provider recommends a particular FDA-approved contraceptive based on a medical determination with respect to that individual, regardless of whether the contraceptive has a therapeutic equivalent, the insurer shall provide coverage, subject to the commission's utilization management procedures, for the prescribed contraceptive drug, device or product without cost-sharing; (ii) FDA-approved emergency contraception available over-the-counter, whether with a prescription or dispensed consistent with the requirements of section 19A of chapter 94C; (iii) prescription contraceptives intended to last: (A) for not more than a 3-month period for the first time the prescription contraceptive is dispensed to the covered person; and (B) for not more than a 12-month period for any subsequent dispensing of the same prescription, which may be dispensed all at once or over the course of the 12-month period, regardless of whether the covered person was enrolled in a plan or policy under this chapter at the time the prescription contraceptive was first dispensed; provided, however, that the insured may not fill more than one 12-month prescription in a single dispensing per plan year; (iv) voluntary female sterilization procedures; (v) patient education and counseling on contraception; and (vi) follow-up services related to the drugs, devices, products and procedures covered under this subsection including, but not limited to, management of side effects, counseling for continued adherence and device insertion and removal. (b) (1) Coverage provided under this section shall not be subject to any deductible, coinsurance, copayment or any other cost-sharing requirement, except as provided for in subclauses (A) and (B) of clause (i) of subsection (a) or as otherwise required under federal law. Coverage offered under this section shall not impose unreasonable restrictions or delays in the coverage; provided, however, that reasonable medical management techniques may be applied to coverage within a method category, as defined by the FDA, but not across types of methods. (2) Benefits for an enrollee under this section shall be the same for the enrollee's covered spouse and covered dependents. (c) Nothing in this section shall be construed to exclude coverage for contraceptive drugs, devices, products and procedures as prescribed by a provider for reasons other than contraceptive purposes, including, but not limited to, decreasing the risk of ovarian cancer, eliminating symptoms of menopause or providing contraception that is necessary to preserve the life or health of the enrollee or the enrollee's covered spouse or covered dependents. (d) The commission shall ensure plan compliance with this chapter. (e) Nothing in this section shall be construed to require the commission to cover experimental or investigational treatments. (f) For purposes of this section, the following words shall have the following meanings unless the context clearly requires otherwise: ''Provider'', an individual or facility licensed, certified or otherwise authorized or permitted by law to administer health care in the ordinary course of business or professional practice acting within the scope of their license. ''Therapeutic equivalent'', a contraceptive drug, device or product that is: (i) approved as safe and effective; (ii) pharmaceutically equivalent to another contraceptive drug, device or product in that it contains an identical amount of the same active drug ingredient in the same dosage form and route of administration and meets compendial or other applicable standards of strength, quality, purity and identity; and (iii) assigned the same therapeutic equivalence code as another contraceptive drug, device or product by the FDA.

M.G.L. c. 32A, § 29 Tobacco cessation

c. 32A, § 29. Tobacco cessation Section 29. (a) The commission shall provide to any active or retired employee of the commonwealth who is insured under the group insurance commission coverage for: (i) tobacco use cessation counseling; and (ii) all generic United States Food and Drug Administration-approved tobacco cessation products without cost sharing when prescribed by a health care provider. (b) The commission may employ reasonable managed care techniques consistent with state and federal law to determine the frequency, method, treatment or setting for the recommended item or service; provided, however, that covered persons shall have access to at least 1 tobacco cessation product without prior authorization.

M.G.L. c. 32A, § 30 Coverage for telehealth services

c. 32A, § 30. Coverage for telehealth services Section 30. (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 mental health, developmental or substance use disorders. ''Telehealth'', the use of synchronous or asynchronous audio, video, electronic media or other telecommunications technology, including, but not limited to: (i) interactive audio-video technology; (ii) remote patient monitoring devices; (iii) audio-only telephone; and (iv) online adaptive interviews, for the purpose of evaluating, diagnosing, consulting, prescribing, treating or monitoring of a patient's physical health, oral health, mental health or substance use disorder condition. (b) Coverage offered by the commission to an active or retired employee of the commonwealth insured under the group insurance commission shall provide coverage for health care services delivered via telehealth by a contracted health care provider if: (i) the health care services are covered by way of in-person consultation or delivery; and (ii) the health care services may be appropriately provided through the use of telehealth; provided, however, that the commission, or its carriers or other contracted entities providing health benefits, shall not meet network adequacy through significant reliance on telehealth providers and shall not be considered to have an adequate network if patients are not able to access appropriate in-person services in a timely manner upon request. Coverage shall not be limited to services delivered by third-party providers. (c) Coverage for telehealth services may include utilization review, including preauthorization, to determine the appropriateness of telehealth as a means of delivering a health care service; provided, however, that the determination shall be made in the same manner as if the service was delivered in person. A carrier shall not be required to reimburse a health care provider for a health care service that is not a covered benefit under the plan or reimburse a health care provider not contracted under the plan except as provided for under subclause (i) of clause (4) of the second sentence of subsection (a) of section 6 of chapter 176O. (d) A health care provider shall not be required to document a barrier to an in-person visit nor shall the type of setting where telehealth services are provided be limited for health care services provided via telehealth; provided, however, that a patient may decline receiving services via telehealth in order to receive in-person services. (e) Coverage for telehealth services may include a deductible, copayment or coinsurance requirement for a health care service provided via telehealth as long as the deductible, copayment or coinsurance does not exceed the deductible, copayment or coinsurance applicable to an in-person consultation or in-person delivery of services. The rate of payment for telehealth services provided via interactive audio-video technology may be greater than the rate of payment for the same service delivered by other telehealth modalities. (f) Coverage that reimburses a provider with a global payment, as defined in section 1 of chapter 6D, shall account for the provision of telehealth services to set the global payment amount. (g) The commission shall ensure that the rate of payment for in-network providers of behavioral health services delivered via interactive audio-video technology and audio-only telephone shall be no less than the rate of payment for the same behavioral health service delivered via in-person methods; provided, that this subsection shall apply to providers of behavioral health services covered as required under subclause (i) of clause (4) of the second sentence of subsection (a) of section 6 of chapter 176O. (h) Health care services provided via telehealth shall conform to the standards of care applicable to the telehealth provider's profession and specialty. Such services shall also conform to applicable federal and state health information privacy and security standards as well as standards for informed consent.

M.G.L. c. 32A, § 31 Benefits for medically necessary emergency services programs to be provided on nondiscriminatory basis

c. 32A, § 31. Benefits for medically necessary emergency services programs to be provided on nondiscriminatory basis Section 31. The commission shall provide to any active or retired employee of the commonwealth who is insured under the group insurance commission benefits on a nondiscriminatory basis for medically necessary emergency services programs, as defined in section 1 of chapter 175.

M.G.L. c. 32A, § 32 Coverage for annual mental health wellness examination

c. 32A, § 32. Coverage for annual mental health wellness examination Section 32. (a) For the purpose of this section, the following words shall have the following meanings: ''Licensed mental health professional'', a licensed physician who specializes in the practice of psychiatry, a licensed psychologist, a licensed independent clinical social worker, a licensed certified social worker, a licensed mental health counselor, a licensed supervised mental health counselor, a licensed psychiatric nurse mental health clinical specialist, a licensed psychiatric mental health nurse practitioner, a licensed physician assistant who practices in the area of psychiatry, a licensed alcohol and drug counselor I, as defined in section 1 of chapter 111J, or a licensed marriage and family therapist within the lawful scope of practice for such therapist. ''Mental health wellness examination'', a screening or assessment that seeks to identify any behavioral or mental health needs and appropriate resources for treatment. The examination may include: (i) observation, a behavioral health screening, education and consultation on healthy lifestyle changes, referrals to ongoing treatment, mental health services and other necessary supports and discussion of potential options for medication; and (ii) age-appropriate screenings or observations to understand a covered person's mental health history, personal history and mental or cognitive state and, when appropriate, relevant adult input through screenings, interviews and questions. ''Primary care provider'', a health care professional qualified to provide general medical care for common health care problems, who: (i) supervises, coordinates, prescribes or otherwise provides or proposes health care services; (ii) initiates referrals for specialist care; and (iii) maintains continuity of care within the scope of practice. (b) Any coverage offered by the commission to an active or retired employee of the commonwealth insured under the group insurance commission shall provide coverage for an annual mental health wellness examination that is performed by a licensed mental health professional or primary care provider, which may be provided by the primary care provider as part of an annual preventive visit. The examination shall be covered with no patient cost-sharing; provided, however, that cost-sharing shall be required if the applicable plan is governed by the Federal Internal Revenue Code and would lose its tax-exempt status as a result of the prohibition on cost-sharing for this service.

M.G.L. c. 32A, § 33 Federally-defined preventive services

c. 32A, § 33. Federally-defined preventive services Section 33. (a) For the purposes of this section, ''federally-defined preventive services'' shall mean: (i) evidence-based items or services that currently have a rating of ''A'' or ''B'' in the recommendations of the United States Preventive Services Task Force; (ii) immunizations with routine use in children, adolescents and adults that currently have a recommendation from the Advisory Committee on Immunization Practices of the federal Centers for Disease Control and Prevention with respect to the individual involved; (iii) with respect to infants, children and adolescents, evidence-informed preventive care and screenings provided for in the comprehensive guidelines supported by the federal Health Resources and Services Administration; and (iv) with respect to women, such additional preventive care and screenings not described in clause (i) as provided for in comprehensive guidelines supported by the federal Health Resources and Services Administration; provided, however, that ''federally-defined preventive services'' shall include all other preventive services not subject to cost-sharing, as required by established federal regulatory and sub-regulatory guidance issued on or before July 1, 2023. (b) The commission shall provide to an active or retired employee of the commonwealth who is insured under the group insurance commission coverage for federally-defined preventive services. (c)(1) Coverage provided pursuant to this section shall not be subject to any cost-sharing, including, but not limited to, co-payments, co-insurance or any deductible, as required by established federal regulatory and sub-regulatory guidance issued on or before July 1, 2023. (2) Benefits for an enrollee pursuant to this section shall be the same for the enrollee's covered spouse and covered dependents. (d) Nothing in this section shall prohibit: (i) coverage for items and services in addition to those recommended by the United States Preventive Services Task Force, the Advisory Committee on Immunization Practices of the federal Centers for Disease Control and Prevention or the federal Health Resources and Services Administration; or (ii) denying coverage for items or services not recommended by the United States Preventive Services Task Force, the Advisory Committee on Immunization Practices of the federal Centers for Disease Control and Prevention or the federal Health Resources and Services Administration. (e) If a recommendation pursuant to subsection (a) is changed during a plan year, a carrier shall not be required to make changes to the health plan during the plan year.

M.G.L. c. 32A, § 34 Medical expense coverage for screening mammograms; diagnostic exams for breast cancer, digital breast tomosynthesis screening, MRIs and ultrasounds

c. 32A, § 34. Medical expense coverage for screening mammograms; diagnostic exams for breast cancer, digital breast tomosynthesis screening, MRIs and ultrasounds [Text of section effective for contracts entered into, renewed or amended on or after January 1, 2026. See 2024, 231, Sec. 7.] Section 34. (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, copayment or similar out-of-pocket expense. ''Diagnostic examinations for breast cancer'', a medically necessary and appropriate examination for breast cancer to evaluate an abnormality in the breast that is seen or suspected from a screening examination for breast cancer, detected by another means of examination or suspected based on the medical history or family medical history of the individual. ''Examination for breast cancer'', an examination used to evaluate an abnormality in a breast using diagnostic mammography, digital breast tomosynthesis, breast magnetic resonance imaging or breast ultrasound. ''HSA-qualified health insurance policy'', a policy of individual or group health insurance coverage that satisfies the criteria for a high-deductible health plan under 26 U.S.C. 223, as implemented and interpreted by the United States Department of the Treasury in the regulations and guidance in effect at the time the policy is issued. (b) Any coverage offered by the commission to an active or retired employee of the commonwealth insured through the commission that provides medical expense coverage for screening mammograms shall provide coverage for diagnostic examinations for breast cancer, digital breast tomosynthesis screening and medically necessary and appropriate screening with breast magnetic resonance imaging or screening breast ultrasound on a basis not less favorable than screening mammograms that are covered as medical benefits. There shall be no increase in patient cost sharing for: (i) screening mammograms; (ii) digital breast tomosynthesis; (iii) screening breast magnetic resonance imaging; (iv) screening breast ultrasound; or (v) diagnostic examinations for breast cancer. (c)(1) Except as provided in paragraph (2), an HSA-qualified health insurance policy shall be exempt from any prohibition on cost-sharing requirements for a covered benefit required under any general or special law to the extent that the exemption is necessary to allow the policy to be an HSA-qualified health insurance policy. (2) The exemption provided in paragraph (1) shall not apply to any coverage required under any general or special law pertaining to preventive care, as described in 26 U.S.C. 223, with respect to any HSA-qualified health insurance policy issued, delivered, amended or renewed while such regulation or guidance is effective.

Source: Massachusetts General Court (malegislature.gov)URL: https://malegislature.gov/Laws/GeneralLaws/PartI/TitleIV/Chapter32AFetched: 10/20/2026