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BOSTON--A Massachusetts agency charged with helping to implement a key part of the state's universal health care reform law is expected to propose draft regulations next week detailing the scope of health insurance coverage state residents must have to avoid tax penalties.
Before the board of directors of the Health Insurance Connector is a staff proposal laying out minimum creditable coverage criteria requirements. Among other things, a health plan, including those offered by employers, could not impose--in order for enrollees to have creditable coverage--an annual dollar maximum on covered expenses, while deductibles could not be imposed on the first three preventative care visits for an individual, or the first six visits per family.
Additionally, the maximum deductible could not exceed $2,000 for individual coverage or $5,000 for family coverage, while the maximum out-of-pocket limit for services delivered in network could not exceed $5,000 for individual coverage and $10,000 for family coverage.
However, health insurance plans linked to health savings accounts would automatically be considered to have met the minimum coverage standards.
Nothing would require plans to meet these standards. But state residents who obtained coverage from plans not complying with the standards would be subject to certain tax penalties.
In a related development, Jon Kingsdale, the Connector's executive director, made clear that self-funded health care plans would not have to offer state mandated benefits, such as coverage for infertility treatment, in order for enrollees to have creditable coverage.
Due to a mistake in "labeling," an earlier Connector document suggested that staff was proposing that such mandates--Massachusetts has many--also apply to self-funded plans.
Mr. Kingsdale said that never was the intent, adding that he believes the Connector lacks the authority to impose--due to federal pre-emption of state laws and rules that relate to employee benefit plans--benefit mandates on self-funded plans.