2007 Non-Group Closed Membership Report

2007 Non-Group Closed Membership Report

Summary of closed nongroup membership:  Total Membership Comparison 2006 to 2007  Total Membership Comparison 2006 to 2007 by county

Closed nongroup total membership by plan by county:  Blue Cross and Blue Shield of Massachusetts, Inc. Total Plan Members Blue Cross and Blue Shield of Massachusetts, Inc. Total Plan Members by county     HMO Total Subscribers

Closed nongroup subscriber membership by plan by county:  Blue Cross and Blue Shield of Massachusetts, Inc. Total Subscribers Blue Cross and Blue Shield of Massachusetts, Inc. Total Subscribers by county     HMO Total Subscribers

Closed nongroup dependent membership by plan by county:  Blue Cross and Blue Shield of Massachusetts, Inc. Total Dependents   Blue Cross and Blue Shield of Massachusetts, Inc. Total Dependents by county     HMO Total Dependents

Introduction

The Division of Insurance ("Division") requested that all nongroup health insurance carriers submit a detailed report by February 8, 2008 regarding the characteristics of their closed nongroup membership as of December 31, 2007.

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. The Massachusetts Legislature passed Section 94 of Chapter 58 of the Acts of 2006 modifying M.G.L. c. 176M §3(d). The statute now states that effective July 1, 2007, a carrier shall no longer offer, sell, or deliver a guaranteed issue health plan to any person to whom it does not have such an obligation pursuant to an individual policy and will be considered a closed guaranteed issue plan. Closed guaranteed issue plans and closed health plan [individual health insurance plans that were in force prior to October 1, 1997] shall be subject to all the other requirements of the statute. Carriers are obligated to renew a closed guarantee issue health plans and closed plans. Carriers may discontinue a closed guarantee issue health plan or a closed plan when the number of subscribers in a closed guaranteed issue plan or a closed plan is less than 25 per cent of the plan's subscriber total as of December 31, 2004.

The following sections of this report describe what is included in the categorical headings used in the accompanying membership charts.

General

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.

Membership 1

Member - Covered person including all subscribers and dependents.

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.