Health Insurance Carriers in Massachusetts (MA)

Massachusetts has its own set of health insurance rules. For your convenience, we have compiled some of the information on those health insurance regulations below. Check out the links as well to learn more about your options.

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Health Insurance Carriers in Massachusetts

Blue Cross Blue Shield of Massachusetts
Harvard Pilgrim HealthCare

Group Health Insurance in Massachusetts

• Group health insurance cannot be denied to eligible applicants, despite health problems.
• Life changes dealing with family, death, and job loss can create additional opportunities for group coverage.
• Employers may require a waiting period before offering insurance.
• The review period for providers to assess pre-existing conditions is six months.
• There is a six month maximum exclusion period for pre-existing conditions.
• A waiting period may be applied to any applicant before coverage begins.
• If continuous coverage has been maintained without a break of over 63 days, exclusion periods are waived.

Small Business Health Insurance in Massachusetts

• Small businesses with up to 50 employees may not be denied small group health coverage.
• Premiums are modified by community rating.
• MassHealth Insurance Partnership assists small employers in paying health premiums, based on income characteristics of the employee group.

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Self-Employed Health Insurance in Massachusetts

• The self-employed may purchase small group health insurance.
• Consult the Massachusetts Division of Insurance about professional associations who offer group health insurance to their members.

Massachusetts Division of Insurance
One South Station
Boston, MA 02110
(617) 521-7794
www.mass.gov/doi

Individual Health Insurance in Massachusetts

• Providers may not deny an applicant due to a health problem.
• The HIPAA eligible follow the same rules for purchasing individual coverage.
• Standardized policies are required for all consumers.
• Providers may offer plans with identical provisions but higher deductibles and co-pays and no prescription drug plan.
• Providers may impose a 6 month waiting period for coverage.
• Providers may exclude coverage for six months on pre-existing conditions if there has been a break of more than 63 days in previous insurance.
• Providers may not attach elimination riders to individual policies.
• Premiums on plans may not be raised based on modified community rating.
• Insurance cannot be cancelled due to illness.
• Conversion policies are available after the loss of a fully insured group policy.

Massachusetts Programs

Financial assistance is provided through MassHealth, Children’s Medical Security Plan, Medical Security Plan, and Breast and Cervical Cancer Treatment Program.

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