- An Overview of Massachusetts Health Benefit Mandates (PDF) | Word (published on January 29, 2014)
- Webinar Presentation (PPT) file size 48MB (With narration) | Word
The Center for Health Information and Analysis (CHIA) is required to evaluate the impact of health benefit mandate bills referred by legislative committees for review. These evaluations provide a medical efficacy analysis, an actuarial estimate of the effect that the proposed benefit mandate would have on the cost of health insurance, and an estimate of state responsibility to defray the cost of additional mandated benefits. CHIA produces reports on each reviewed benefit mandate proposal and performs a comprehensive retrospective review, typically every four years, of all mandates in effect.
Health benefit mandates are laws passed by states that require state licensed health insurance carriers to include specific health care benefits in certain coverage plans. All states have such benefit mandates. Examples range from commonly offered services, such as emergency department services or diabetic supplies, to less standard benefits, such as in vitro fertilization and applied behavior treatment for autism. While mandates may make health insurance more comprehensive, they also may make it more expensive. Thus, 29 states, including Massachusetts, have systematic processes in place to study the efficacy and cost of existing and proposed health benefit mandates
The review of health benefit mandates supports balancing the goal of ensuring adequate protection for health care consumers with the goal of managing increasing health care costs. The new requirements introduced by the Federal Affordable Care Act (ACA) may impact the types and number of benefit mandate bills passed in Massachusetts. By evaluating the medical efficacy, cost impact, and state liability of proposed benefit mandate bills, CHIA will continue to provide stakeholders with neutral, reliable information.
Health Plans Subject to Benefit Mandates
|Commercial Health Insurance Companies|
|Hospital Service Corporations|
|Medical Service Corporations|
|Group Insurance Commission (GIC) Plans|
Health Plans Not Subject to Benefit Mandates
(Except the GIC population for some mandates)
|Employer pays for employees’ health care costs out of a fund that the company has set aside for medical expenses.|
|Federal Employees Health Benefit Program||Employer-sponsored group health insurance program for federal workers, dependents, and retirees.|
|TRICARE (military and dependents)||Health care program serving Uniformed Service members, retirees and their families, managed by the federal Defense Health Agency (DHA).|
|Medicare||Federal health insurance program for people who are 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease.|
Joint federal-state health insurance program with eligibility standards based on income or other criteria.