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Mass. General Laws c.176G

Health maintenance organizations

This page links to the current version of each section of G.L. c.176G.

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§ 1 Definitions 
§ 2 Application of laws 
§ 3 Organization; accounting; contracts 
§ 4 Required coverage for certain conditions and groups 
§ 4A Employees terminated due to plant closings; coverage 
§ 4B Confidentiality of information; mental or nervous condition; exceptions 
§ 4C Home care benefits 
§ 4D Nonprescription enteral formulas for home use 
§ 4E Off-label drug use; cancer treatment 
§ 4F Group health maintenance contracts; coverage for bone marrow transplants 
§ 4G Off-label use of prescription drugs for HIV/AIDS treatment 
§ 4H Items medically necessary for diagnosis and treatment of diabetes 
§ 4I Prenatal, childbirth and postpartum care benefits; minimum coverage for in-patient care 

Amended by St.2022, c. 127, §§ 30-31, effective July 29, 2022

§ 4J Scalp hair prostheses necessary due to cancer or leukemia treatment 
§ 4K Newborn hearing screening tests 
§ 4L Coverage for hospice services 
§ 4M Mental health benefits; biologically-based mental disorders; rape-related mental disorders; non-biologically-based mental disorders of children and adolescents under age 19 

Amended by St.2022, c.177, § 59, effective November 8, 2022

§ 4N Coverage for speech, hearing and language disorders; hearing aids 
§ 4O Outpatient services; hormone replacement therapy for peri and post menopausal women; contraceptive services; approved prescription contraceptive drugs or devices; exception 

Amended by St.2017, c. 120, § 6, effective November 20, 2017

§ 4P Patient care services provided pursuant to qualified clinical trials 
§ 4Q Coverage for human leukocyte or histocompatibility locus antigen testing 
§ 4S Coverage for prosthetic devices and repairs 
§ 4T Coverage for eligible dependents under 26 years of age 

Amended by St.2022, c.177, § 60, effective November 8, 2022

§ 4U Coverage for medically necessary hypodermic syringes or needles 
§ 4V Coverage for diagnosis and treatment of autism spectrum disorder 
§ 4W Coverage for children under age 18 for cleft lip and cleft palate 
§ 4X Coverage for orally administered anticancer medications 
§ 4Y Coverage for abuse deterrent opioid drug products 
§ 4Z Preauthorization for substance abuse treatment not to be required 

Amended by St.2018, c. 208, § 89, effective August 9, 2018

§ 4AA Coverage for medically necessary acute treatment and clinical stabilization services 

Amended by St.2018, c. 208, § 90, effective August 9, 2018

§ 4BB Coverage for long-term antibiotic therapy for patients with Lyme disease 
§ 4CC Coverage for medical or drug treatments to correct or repair disturbances of body composition caused by HIV associated lipodystrophy syndrome 
§ 4DD Filling of remaining portion of prescription for covered drug that is a narcotic substance earlier filled in lesser quantity 

Amended by St.2018, c. 208, § 91, effective August 9, 2018

§ 4EE Pain management access plans 

Amended by St.2018, c. 208, § 91, effective August 9, 2018

§ 4FF Tobacco use cessation 

Added by St.2019, c.133, § 23, effective November 27, 2019

§ 4GG Coverage for treatment of pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections and pediatric acute-onset neuropsychiatric syndrome 

Added by St.2020, c.260, § 52, for contracts that take effect or are renewed on or after January 1, 2022

§ 4II Prescription eye drops 

Added by St.2021, c.29, § 26, effective July 1, 2021

§ 4JJ Individual or group health maintenance contracts; coverage for mental health or substance use disorders delivered through the psychiatric collaborative care model 

Added by St.2022, c.177, § 61, effective November 8, 2022

§ 4KK Individual or group health maintenance contracts; provision of mental health or community-based acute treatment; preauthorization 

Added by St.2022, c.177, § 61, effective November 8, 2022

§ 4LL Individual or group health maintenance contract; nondiscrimination 

Added by St.2022, c.177, § 61, effective November 8, 2022

§ 4MM Individual or group health maintenance contract; annual mental health wellness examinations; guidelines 

Added by St.2022, c.177, § 61, effective November 8, 2022

§ 4NN Federally-defined preventive services; coverage 

Added by St.2023, c.28, § 60, effective July 1, 2023.

§ 5 Emergency services provided to members for emergency medical conditions 
§ 5A Divorced or separated spouses; coverage 
§ 6 Contracts 
§ 6A Group health maintenance contracts; contribution percentages 
§ 6B Retroactive claims denials for behavioral health services 

Added by St.2019, c. 41, § 58, effective July 1, 2019

§ 8 Public dissemination of deceptive or misleading materials 
§ 9 Trade regulation practices; application of law 
§ 10 Reports; audits, examinations or inspections; confidentiality and privilege 
§ 10A Applicability of chapter 176V to health maintenance organization governed by this chapter 
§ 10B Applicability of chapter 176W to health maintenance organizations governed by this chapter 
§ 11 Contracts with group insurance commission or local governments 
§ 11A Alternative dental coverage option 
§ 12 Health regulations not limited 
§ 13 Name restriction 
§ 14 Licensure applicants; documents required; approval by commissioner 
§ 15 Bond; waiver 
§ 16 Contracts, rates, evidence of coverage; disapproval of commissioner 
§ 16A Disapproval of certain health maintenance contracts based on high deductibles 
§ 16B Disapproval of certain health maintenance contracts for coverage of young adults 
§ 17 Rules and regulations; standardized claim form 
§ 17A Open enrollment for nongroup medicare beneficiaries; period, notice of termination 
§ 19 Discrimination against abuse victims in terms of health maintenance contract 
§ 20 Insolvent health maintenance organization; administrative supervision, rehabilitation or liquidation; priority of claims 
§ 20A Administrative supervision, rehabilitation or liquidation of health maintenance organizations; revocation or suspension of license 
§ 21 Participating provider; contracts with health maintenance organizations; hold harmless clause; limitation on collection actions 
§ 22 Health care providers; liability of member of health maintenance organization; limitation on collection of amounts owed 
§ 23 Insolvency of health maintenance organization; replacement coverage 
§ 24 Health maintenance contracts; genetic tests; discrimination based on genetic information 
§ 25 Net worth of health maintenance organization 
§ 26 Deposit maintained with trustee acceptable to commissioner 
§ 27 Merger or acquisition of control 
§ 28 Registration with commissioner 
§ 29 Violations of Secs. 27 to 29; application for order enjoining violations of Secs. 27 to 29; penalties 
§ 30 Statement for individuals provided with creditable coverage; reporting 
§ 31 Attribution of members to a primary care provider 
§ 32 Disclosure of patient-level data and contracted prices of individual health care services by carriers to providers 
§ 33 Coverage for telehealth services 

Added by St.2020, c.260, § 53, effective January 1, 2021

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