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Press Release:

MA Health Care Reform FAQ's

If the employee refuses employer sponsored coverage and does not file a Health Insurance Responsibility Disclosure (HIRD), what liability does the employee have, and what are the state's options for those employees who disregard the state mandates?

Effective July 1, 2007, all adult residents of Massachusetts are required to have health insurance coverage that meets the minimum creditable coverage standards adopted by the Connector Board. Individuals who do not have coverage will be subject to a tax penalty unless they obtain an exemption from the waiver from the Connector. The Connector will adopt standards through which individuals who cannot afford coverage can apply for an exemption.

Has there been any update on Minimal Creditable Coverage?

The Connector Board has agreed upon draft regulations. Under the draft regulations, effective July 1, 2007, any health plan qualifies as minimum creditable coverage. Effective January 1, 2009, stricter standards will apply. These standards include a limit on deductibles and out-of-pocket costs and will require all plans to include prescription drug coverage. These standards still need to be finalized by the Connector Board following public hearings to be held later this spring. Here is a link to the draft regs: MA Draft Regulations

The new section 125 law states "you cannot have more than a two month waiting period for eligibility in the Section 125". Does this apply to the health insurance eligibility waiting period? In other words, can a company still require new employees to wait 90 or 120 days before they can elect the health insurance coverage?

The employee must have the option of purchasing coverage on a pre-tax basis through a Section 125 plan beginning no later than day 60, even if the employer is not contributing anything towards the cost of coverage.

Another provision of the health reform law requires fully-insured employers to offer all full-time employees the same coverage options (the non-discrimination requirement). The Department of Insurance (DOI) is expected to issue clarifying guidance on this provision, including the guidance on the use of probationary periods. If the DOI allows a waiting period of more than 60 days, then potentially, an employer could require an employee to pay 100% of the cost of coverage through the Section 125 plan starting on day 60 until the end of the employer's probationary period. If the employer uses the Connector for its non-benefit eligible employees, then this employee could enroll through the COnnector with the payroll deduction facilitated by the employer and then switch to the employer's plan at the end of the employer's waiting period.

The new Section 125 law - How and when will employers file their Section 125 plan doc to the state?

To be determined.

When will Health Insurance Responsibility Disclosure (HIRD) actual forms and procedures be available?

Regulations and forms are expected to be issued soon.

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