This chapter describes the protections that you have in group health plans, such as those offered by employers or labor unions. Your protections will vary somewhat, depending on whether your plan is a fully insured group health plan or a self-insured group health plan.  The plan’s benefits information must indicate whether the plan is self-insured.

As of July 1, 2007 Massachusetts requires all individuals over 18 years of age (with some exceptions) to have health insurance.  By December 31, 2007, all Massachusetts residents will be required to provide the state with proof of health insurance coverage or face penalties.   In 2007, those who fail to provide proof of qualifying coverage can lose their personal tax exemption when filing state taxes. Starting in 2008, individuals who don’t have coverage can be fined an amount equal to 50% of the annual premium for the least costly available qualifying health insurance.

Until 2009, people can comply with the individual mandate by obtaining coverage under any type of health benefit plan, whether provided by an employer or purchased privately. However, in 2009, people must have coverage that meets certain benefit standards.  Starting January 1, 2009, to qualify as minimum creditable coverage, an insurance policy must at least provide coverage for preventative and primary care, emergency services, hospitalization, prescription drugs and mental health benefits. 

For more information on these requirements, visit The Commonwealth Connector on the web at http://www.mahealthconnector.org/.