|Massachusetts Membership in|
Closed Nongroup Health Insurance Plans
as of December 31, 2004
Summary of closed nongroup membership:
Total Membership Comparison 2003 to 2004
Closed nongroup total membership by plan by county:
Blue Cross and Blue Shield of Massachusetts, Inc. Total Plan Members
HMO Total Subscribers
Closed nongroup subscriber membership by plan by county:
Blue Cross and Blue Shield of Massachusetts, Inc. Total Subscribers
HMO Total Subscribers
Closed nongroup dependent membership by plan by county:
Blue Cross and Blue Shield of Massachusetts, Inc. Total Dependents
HMO Total Dependents
|The Division of Insurance ("Division") requested that all nongroup health insurance carriers submit a detailed report by February 11, 2005 regarding the characteristics of their closed nongroup membership as of December 31, 2004.|
What Are Closed Nongroup Health Insurance plans?
|According to M.G.L. c. 176M any carrier who is offering health coverage to eligible individuals in Massachusetts after October 1, 1997 may only offer guaranteed issue health insurance plans which must be offered to all eligible persons without medical underwriting, pre-existing condition limitations or waiting periods. Rates charged to eligible persons may only vary according to the specific rating factors allowed by M.G.L. c. 176M.|
Closed Nongroup Plans are individual health insurance plans that do not meet the requirements of M.G.L. c. 176M and were in force prior to October 1, 1997 and closed to new enrollments as of that date. Originally, M.G.L. c. 176M required that these plans were to be phased out after three years, but prior to the plans being closed out, the Massachusetts Legislature passed Section 14 of Chapter 140 modifying M.G.L. c. 176M, § 3(d). The statute now requires carriers to renew closed plans, but a carrier may discontinue a closed plan only when the number of subscribers in said plan is not more than 25% of the plan's 1999 enrollment figure based on enrollment figures submitted to the Division as of December 31, 1999. A carrier wishing to terminate a closed plan must obtain the approval of the Commissioner of Insurance based on the most recent figures submitted to the Division.
The following sections of this report describe what is included in the categorical headings used in the accompanying membership charts.
|Company - Name of the licensed carrier offering the guarantee issue product. This is not the name of a provider network or third party administrator but rather the licensed carrier that bears the financial risk.|
County - County in which the subscriber resides.
|Member - Covered person including all subscribers and dependents.|
Subscriber - Subscriber - "Contractholder" who is an eligible individual who has enrolled alone, or with his or her dependents for whom the carrier has accepted the risk of financing necessary health services via a guarantee issue nongroup plan. A Subscriber should be reported by county according to the zip code of the Subscriber's primary residence listed on the application for coverage.
Dependent - Eligible individual who is enrolled for guarantee issue Nongroup coverage and is not the Subscriber or Contractholder of record and was specially named as a dependent in the application for coverage. A Dependent should be reported by county according to the zip code of the Dependent's primary residence listed on the application for coverage.
1Excludes members in nongroup guaranteed issue health insurance plans as well as persons in nongroup guaranteed issue health insurance plans available only on a group conversion basis. See separate reports for membership in nongroup guaranteed issue health insurance plans.