What does OPP do?

OPP provides the following assistance to consumers:

  • Internal Grievances and External Reviews - Health insurance consumer appeals, for people with “fully-insured” Massachusetts health plans who want to dispute certain kinds of health insurance claims decisions
  • Waiver Form pdf format of Waiver Form
– Enrollment waivers, which may allow certain individuals and families to buy health insurance when enrollment is not open
  • General information for consumers about health insurance

OPP also collects and posts certain information reported by health insurance companies who offer insurance plans in Massachusetts

History of the Office of Patient Protection

Frequently Asked Questions

Statistics and Reports

Questions?

  • You can contact OPP by phone at 1-800-436-7757 or by email at HPC-OPP@state.ma.us. We cannot accept external review requests, enrollment waiver requests, or any personal health information by email.
  • OPP was formerly located at the Massachusetts Department of Public Health (DPH).  Chapter 224 of the Acts of 2012 moved OPP from DPH to the Health Policy Commission.  The move took place on April 20, 2013.  Learn more about the implementation of Chapter 224.

Useful Definitions

Fully-insured:  

A health plan purchased by an employer from an insurance company.  Fully-insured plans are usually regulated by state government.

Self-funded/self-insured

Under a self-insured or self-funded plan, your employer pays the costs for its employees' health care directly instead of paying premiums to buy health insurance.  Some self-insured employers hire insurance companies to process the paperwork, so it is not always easy to tell if you are in a self-funded plan.  Contact your employer to find out if your plan is self-insured. Self-insured plans are usually regulated by the federal government.

Nongroup insurance

Nongroup insurance means health insurance that you buy for yourself or your family from the Health Connector or from an insurance company or insurance agent.

Open enrollment

Under Massachusetts and federal law there are only certain times during the year when individuals and families may buy nongroup health insurance coverage.  The time when individuals and families can apply – the time when health insurers open plans to new members – is called “open enrollment.”  This is similar to the process employers use to allow their employees to sign up or change plans during specified times only