This bill prohibits health insurance carriers from including "termination without cause" clauses or unilateral changes to material contract terms (such as payment rates, service definitions, or quality policies) with healthcare providers. It requires carriers to provide written notice of any change at least 90 days before the provider must respond, and limits such changes to occur only after a contract's current term ends. The law specifically applies to state health insurance purchasing entities (like MassHealth) and their contracts with providers. It allows mutually agreed amendments but bans unilateral modifications except as required by law.
H 5062 establishes rules for how health insurers and injured people split recovery money from third-party injury claims. It requires that insurers' reimbursement claims be limited to the proportion of medical benefits they paid relative to the injured person's total damages. If the settlement or judgment is less than the full damages, courts can reduce the insurer's claim after reviewing the case. The bill also creates a court process for resolving disputes over fair allocation of recovery funds, including attorney fees, when the injured person and insurer cannot agree. This directly affects injured individuals, health insurers, and hospitals that provided medical benefits.
H 5018 requires all health insurance policies in Massachusetts - covering group, individual, and hospital service plans - to reimburse hospital-at-home services equally with in-person care. It applies to any policy providing hospital or surgical coverage (excluding Medicare supplemental plans) and mandates coverage for services from hospitals participating in the federal CMS Acute Hospital Care at Home Program. The law ensures insurers pay for these services at the same rate as traditional hospital visits, without additional patient cost-sharing. This affects all Massachusetts health insurers and their policyholders, including Commonwealth employees covered under group insurance. The bill does not create new services but standardizes existing insurance coverage for this care option.
H 5039 establishes the Massachusetts Merged Market Advisory Council to study the state’s combined health insurance market for small businesses and individuals (regulated under Chapter 176J). The council, composed of 13 members including industry experts and government officials, will analyze market data, identify affordability challenges, and recommend policy changes to stabilize coverage. It must submit a final report with findings and suggestions by December 2026, considering factors like premium trends, cross-subsidization, and new coverage options. This bill directly affects small employers and individuals purchasing health insurance in Massachusetts’ merged market.
H 5046 ("Freddy’s Law") requires all Massachusetts high school athletes participating in MIAA sports to undergo one electrocardiogram (EKG) screening before competing, starting in the 2026-2027 school year. The bill mandates that all health insurance plans sold in Massachusetts - including state employee coverage, employer group plans, and individual policies - must cover this screening at no cost to families. It also directs the state to work with the MIAA to create policies covering athlete compliance, handling abnormal results, religious exemptions, and sharing screening results across schools. The law directly affects all high school athletes in MIAA sports and their insurance providers, ensuring EKG screenings are accessible without out-of-pocket costs.
This bill requires health insurance plans in Massachusetts to cover and reimburse new telehealth services, including e-consults (provider-to-provider digital advice), e-visits (patient-initiated digital check-ins), and remote monitoring of health data. It directly affects patients seeking virtual care, healthcare providers delivering telehealth services, and insurance carriers. Key provisions mandate coverage for these services without extra prior authorization compared to in-person visits, include interpreter services for non-English speakers or Deaf patients, and require insurers to offer digital health literacy programs for patients with low tech skills. The bill also creates a shared portal for applying to affordable broadband programs to support digital access.
This bill (H 5041) requires all health insurance plans covering specific groups in Massachusetts to provide coverage for medically necessary treatment of three genetic craniofacial conditions: ectodermal dysplasia, dentinogenesis imperfecta, and amelogenesis imperfecta. It mandates coverage for functional repair or restoration of craniofacial disorders caused by congenital conditions, excluding cosmetic procedures, unrelated dental work, and cleft lip/palate (which is covered under separate provisions). The coverage must not impose higher deductibles, copays, or out-of-pocket limits than other benefits in the plan. It applies to group insurance for state employees, state health division programs, private health insurance policies, hospital service plans, and health maintenance organizations. The bill does not create new benefits but ensures existing plans cover these specific conditions equally with other medical treatments.
H 5022 prohibits health insurance companies from denying payment for covered services solely because a patient received a referral from a doctor outside the insurance network. This affects patients seeking care from non-network providers and requires insurers to cover services under the same terms as network referrals. The bill amends multiple sections of Massachusetts health insurance laws (including Chapters 32A, 32B, 94C, 175, 176A, 176B, 176G, and 176I) to include this uniform rule. It takes effect one year after enactment for all new, renewed, or amended insurance contracts.
This bill requires public employers (such as state, city, or fire district departments) to provide full-time firefighters with free cancer screenings every three years, starting three years after they begin working as firefighters. It covers screenings for 11 specific cancers including colon, lung, bladder, and prostate, with all costs paid by the employer's health plan - no co-pays or deductibles required. The mandate applies to firefighters in municipal departments, the Massachusetts Military Reservation, the 104th Fighter Wing, and Devens fire departments. The only exception is if the employer's health plan is federally tax-exempt and would lose that status without cost-sharing, though this is uncommon.
This bill (H 4899) requires health insurance plans in Massachusetts to cover post-pregnancy mental health care - including postpartum and post-miscarriage care - without any out-of-pocket costs like deductibles or copays. It applies to both private insurance and Medicaid plans, ensuring coverage is equally available to enrollees and their spouses or dependents. The law explicitly adds this care to existing pregnancy-related coverage requirements in multiple sections of state health laws and prohibits unreasonable delays or restrictions in accessing these services.
