- What are the rules governing eligibility as a dependent in an insured health plan?
- Are medical reimbursement accounts considered insurance and should insurance providers send Form MA 1099-HC to members and the data to DOR for these accounts?
- What is "Minimum Creditable Coverage" (MCC)?
1. What are the rules governing eligibility as a dependent in an insured health plan?
Effective January 1, 2007, if you have an insured benefit plan that provides coverage for dependents, your child can stay on your plan through the earlier of
- Their 26th birthday
- The day two years following the loss of their dependent status according to federal tax rules
If your plan is a self-insured plan, check with your plan sponsor to find out how long dependents can stay on your plan. For more information on the personal income tax treatment of this benefit, see TIR 07-16 .
As of January 1, 2007, carriers may not impose any limitations on eligibility for dependent coverage, other than limitations defining familial relationships under the policy (e.g., spouse and children, or spouse, children and parents) and any other limitations that may be permitted under the statute.
2. Are medical reimbursement accounts considered insurance and should insurance providers send Form MA 1099-HC to members and the data to DOR for these accounts?
No. Medical reimbursement accounts are not considered health insurance and the administrator should not issue a Form MA 1099-HC to the member and should not include these in the data sent to DOR.
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3. What is "Minimum Creditable Coverage" (MCC)?
Minimum creditable coverage (MCC) is the "floor" of benefits that adult tax filers need to have to be considered insured and avoid tax penalties in Massachusetts. The Massachusetts Health Connector defines the set of benefits needed to meet MCC in the regulations it issues.
Some plans meet MCC automatically
For most plans, the "Minimum Creditable Coverage" standards include:
- Coverage for a comprehensive set of services (e.g. doctors visits, hospital admissions, day surgery, emergency services, mental health and substance abuse, and prescription drug coverage).
- Doctor visits for preventive care, without a deductible.
- A cap on annual deductibles of $2,000 for an individual and $4,000 for a family.
- For plans with up-front deductibles or co-insurance on core services, an annual maximum on out-of-pocket spending of no more the annual limit set by the IRS for high deductible health plans. In 2014, out-of-pocket costs are limited to $6,350 for an individual plan ant $12,700 for a family plan.
- No caps on total benefits for a particular illness or for a single year.
- No policy that covers only a fixed dollar amount per day or stay in the hospital, with the patient responsible for all other charges.
- For policies that have a separate prescription drug deductible, it cannot exceed $250 for an individual or $500 for a family.