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Mass. finalizes health plan coverage test


BOSTON--Effective Oct. 1, employers in Massachusetts will have to comply with newly finalized regulations that spell out whether they will be subject to a special assessment mandated by the state's landmark health care reform law.

Under a provision in the law, companies with at least 11 full-time employees in the state are subject to an annual assessment of up to $295 per year per full-time employee if they do not provide a "fair and reasonable" health insurance premium contribution.

Revenues raised by the assessment will be directed into a fund used to subsidize health insurance premiums for lower-income individuals and thus expand the number of state residents with coverage.

Under the final regulations, issued by the state's Division of Health Care Finance and Policy and which closely follow rules the division proposed in late June, employers that pass either of two tests would be considered to have made a fair and reasonable contribution and thus be exempt from the assessment.

Under the primary test, if at least 25% of an employer's full-time employees are enrolled in its group health insurance plans, that employer would pass the fair and reasonable test.

If the 25% enrollment threshold is not met, employers that offer to pay at least 33% of the premium for individual coverage would pass the fair and reasonable test.

Benefit experts said earlier that they doubt whether any large or midsize company would have difficulty passing either test.