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Mass. health reform agency set to decide coverages

Posted On: May. 30, 2007 12:00 AM CST

BOSTON--The board of the Massachusetts agency charged with implementing key parts of the state's sweeping health care reform law is scheduled to make a decision next week on the breadth of health care coverage that state residents must have.

Unless they receive a special waiver or the cost is considered unaffordable based on their income, individuals must be enrolled by Jan. 1, 2009, in plans that meet state design requirements. State residents who do not enroll face significant financial penalties.

The requirements for plans to be considered as meeting minimum coverage, which the board of directors of the Massachusetts Health Insurance Connector Authority proposed earlier, include:

  • Not imposing annual limits on how much a health plan will pay for covered services.

  • Limiting annual deductibles for in-network covered services to $2,000 for individual coverage or $4,000 for family coverage.

  • Capping the annual out-of-pocket limit, including deductibles, for in-network services at $5,000 for individual coverage and $10,000 for family coverage.

  • If carved out from a health care plan, capping annual deductibles for prescription drug coverage at $250 for individual coverage and $500 for family coverage.

    Additionally, high-deductible health insurance plans linked to health savings accounts automatically would be considered minimum creditable coverage.

    The board is scheduled to make its final decision on June 6.

    The goal of the 2006 law is to achieve near-universal health care coverage within a few years. State officials said they believe they are on track to meeting that objective.