- 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, the Health Care Reform Act (Chapter 58 of the Acts of 2006, as amended) requires that carriers with insured health benefit plans that provide for dependent coverage make coverage available for persons through the earlier of their 26th birthday or the day two years following the loss of their dependent status according to federal tax rules.
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)?
Individuals must be enrolled in health insurance policies that meet minimum creditable coverage (MCC) standards defined in regulations adopted by the Commonwealth Health Insurance Connector Authority (the Connector). MCC is the "floor" of benefits that adult tax filers need to be considered insured and avoid tax penalties in Massachusetts.
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 than $5,000 for an individual and $10,000 for a family.
- 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.
Additional information and MCC Resources can be found on the Connector's website.
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