Health Maintenance Organizations

  1. Law
  2. Massachusetts General Laws
  3. Administration of the Government
  4. Corporations
  5. Health Maintenance Organizations

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Section
1

Definitions

Section
2

Application of Laws

Section
3

Organization; Accounting; Contracts

Section
4

Required Coverage for Certain Conditions and Groups

Section
4a

Employees Terminated Due to Plant Closings; Coverage

Section
4aa

Coverage for Medically Necessary Acute Treatment and Clinical Stabilization Services

Section
4b

Confidentiality of Information; Mental or Nervous Condition; Exceptions

Section
4bb

Coverage for Long-Term Antibiotic Therapy for Patients With Lyme Disease

Section
4c

Home Care Benefits

Section
4cc

Coverage for Medical or Drug Treatments to Correct or Repair Disturbances of Body Composition Caused by HIV Associated Lipodystrophy Syndrome

Section
4d

Nonprescription Enteral Formulas for Home Use

Section
4dd

Filling of Remaining Portion of Prescription for Covered Drug That Is a Narcotic Substance Earlier Filled in Lesser Quantity

Section
4e

Off-Label Drug Use; Cancer Treatment

Section
4ee

Pain Management Access Plans

Section
4f

Group Health Maintenance Contracts; Coverage for Bone Marrow Transplants

Section
4ff

Coverage for Tobacco Use Cessation Counseling and Tobacco Cessation Products

Section
4g

Off-Label Use of Prescription Drugs for HIV/AIDS Treatment

Section
4h

Items Medically Necessary for Diagnosis and Treatment of Diabetes

Section
4i

Prenatal, Childbirth and Postpartum Care Benefits; Minimum Coverage for In-Patient Care

Section
4j

Scalp Hair Prostheses Necessary Due to Cancer or Leukemia Treatment

Section
4k

Newborn Hearing Screening Tests

Section
4l

Coverage for Hospice Services

Section
4m

Mental Health Benefits; Biologically-Based Mental Disorders; Rape-Related Mental Disorders; Non-Biologically-Based Mental Disorders of Children and Adolescents Under Age 19

Section
4n

Coverage for Speech, Hearing and Language Disorders; Hearing AIDS

Section
4o

Outpatient Services; Hormone Replacement Therapy for Peri and Post Menopausal Women; Contraceptive Services; Approved Prescription Contraceptive Drugs or Devices; Exception

Section
4p

Patient Care Services Provided Pursuant to Qualified Clinical Trials

Section
4q

Coverage for Human Leukocyte or Histocompatibility Locus Antigen Testing

Section
4r

Repealed, 2008, 451, Sec. 140

Section
4s

Coverage for Prosthetic Devices and Repairs

Section
4t

Coverage for Eligible Dependents Under 26 Years of Age

Section
4u

Coverage for Medically Necessary Hypodermic Syringes or Needles

Section
4v

Coverage for Diagnosis and Treatment of Autism Spectrum Disorder

Section
4w

Coverage for Children Under Age 18 for Cleft Lip and Cleft Palate

Section
4x

Coverage for Orally Administered Anticancer Medications

Section
4y

Coverage for Abuse Deterrent Opioid Drug Products

Section
4z

Preauthorization for Substance Abuse Treatment Not to Be Required

Section
5

Emergency Services Provided to Members for Emergency Medical Conditions

Section
5a

Divorced or Separated Spouses; Coverage

Section
6

Contracts

Section
6a

Group Health Maintenance Contracts; Contribution Percentages

Section
6b

Retroactive Claims Denials for Behavioral Health Services

Section
7

Repealed, 2000, 141, Sec. 21

Section
8

Public Dissemination of Deceptive or Misleading Materials

Section
9

Trade Regulation Practices; Application of Law

Section
10

Reports; Audits, Examinations or Inspections; Confidentiality and Privilege

Section
10a

Applicability of Chapter 176v to Health Maintenance Organization Governed by This Chapter

Section
10b

Applicability of Chapter 176w to Health Maintenance Organizations Governed by This Chapter

Section
11

Contracts With Group Insurance Commission or Local Governments

Section
11a

Alternative Dental Coverage Option

Section
12

Health Regulations Not Limited

Section
13

Name Restriction

Section
14

Licensure Applicants; Documents Required; Approval by Commissioner

Section
15

Bond; Waiver

Section
16

Contracts, Rates, Evidence of Coverage; Disapproval of Commissioner

Section
16a

Disapproval of Certain Health Maintenance Contracts Based on High Deductibles

Section
16b

Disapproval of Certain Health Maintenance Contracts for Coverage of Young Adults

Section
17

Rules and Regulations; Standardized Claim Form

Section
17a

Open Enrollment for Nongroup Medicare Beneficiaries; Period, Notice of Termination

Section
18

Repealed, 1993, 110, Sec. 214

Section
19

Discrimination Against Abuse Victims in Terms of Health Maintenance Contract

Section
20

Insolvent Health Maintenance Organization; Administrative Supervision, Rehabilitation or Liquidation; Priority of Claims

Section
20a

Administrative Supervision, Rehabilitation or Liquidation of Health Maintenance Organizations; Revocation or Suspension of License

Section
21

Participating Provider; Contracts With Health Maintenance Organizations; Hold Harmless Clause; Limitation on Collection Actions

Section
22

Health Care Providers; Liability of Member of Health Maintenance Organization; Limitation on Collection of Amounts Owed

Section
23

Insolvency of Health Maintenance Organization; Replacement Coverage

Section
24

Health Maintenance Contracts; Genetic Tests; Discrimination Based on Genetic Information

Section
25

Net Worth of Health Maintenance Organization

Section
26

Deposit Maintained With Trustee Acceptable to Commissioner

Section
27

Merger or Acquisition of Control

Section
28

Registration With Commissioner

Section
29

Violations of Secs. 27 to 29; Application for Order Enjoining Violations of Secs. 27 to 29; Penalties

Section
30

Statement for Individuals Provided With Creditable Coverage; Reporting

Section
31

Attribution of Members to a Primary Care Provider

Section
32

Disclosure of Patient-Level Data and Contracted Prices of Individual Health Care Services by Carriers to Providers