Bill > S535

This bill aims to alleviate health care burdens for Massachusetts employers by modifying existing laws related to health insurance for small businesses and individuals. Key provisions include removing the definition of "eligible individual" and replacing references to "an individual or group" with "a group" in certain contexts, thereby focusing regulations more on group coverage. It also redefines "health benefit plan" to encompass various types of group insurance and service plans. The bill introduces new rules for how carriers, which are insurance companies, develop premium rates for eligible small groups, requiring them to consider all enrollees in a single risk pool and limiting the factors they can use for rate adjustments to age, geographic region, family coverage, and tobacco use, with specific limitations on how these factors can be applied. Furthermore, it mandates that carriers make all their health benefit plans available to every eligible small business and clarifies conditions under which carriers can deny enrollment or refuse to renew coverage for small businesses and individuals, such as non-payment of premiums or fraud. The bill also introduces provisions for out-of-network coverage when services are unavailable within a provider network, requires clear disclosure of cost-sharing differences in tiered network plans, mandates efforts to assign members to primary care providers, and allows for the disclosure of patient-level data to network providers for care coordination and management purposes, with specific limitations to protect privacy.