HEALTH PLANS OFFERED IN 2008 SHOULD MEET NEW STANDARDS

Massachusetts health reform will soon require most employees to have health insurance coverage that
meets minimum creditable coverage (MCC) standards. Businesses across the state are being reminded
that health insurance plans their employees purchase through them will need to meet these standards,
including prescription drug coverage, in order for the employees to comply with the Massachusetts
health reform law.

Even though these new standards do not take effect until Jan. 1, 2009, the Health Connector is mailing
information to more than 190,000 businesses this month. If employers want to offer MCC-compliant
plans in time for Jan. 1, 2009, they have to begin early in 2008.

“Businesses offering insurance to new employees and holding open enrollments in 2008 should
consider offering plans that meet these standards so their employees will have access to
comprehensive coverage and not be subject to a tax penalty,” said Health Connector Executive
Director Jon Kingsdale.

Come Jan. 1, 2009, individuals enrolled in plans that do not meet the minimum standards may be
subject to a tax penalty for every month they have inadequate coverage. Since enrollment in a plan is
for 12 months, coverage purchased after Jan. 1, 2008, will extend into 2009 and, therefore, should
meet the new requirements.

Beginning Jan. 1, 2009, employees must have health insurance plans that provide:

• Primary and preventive care
• Emergency services
• Hospitalization benefits
• Diagnostic surgery
• Prescription drug coverage. Any separate prescription drug coverage deductible may not
exceed $250 for an individual and $500 for a family
• Ambulatory patient services
• Mental health services
• No annual or per-sickness benefit maximum
• No per diem limit on in-patent care
• Annual deductibles capped at $2,000 for individual and $4,000 for family coverage
• Annual out-of-pocket spending capped at $5,000 for an individual and $10,000 for a family
receiving in-network services, if the plan includes a deductible or co-insurance on core
medical services
• Any out-of-pocket maximum must include the upfront deductible, most co-insurance and any
service that requires a co-payment of $100 or more
• A minimum of three visits to the doctor for an individual and six for a family prior to any
upfront deductible

Click Here to read the full Article:

https://www.hsabrokers.com/pdf/HealthReform/HealthReformBasics-of-MCC-Requirements.pdf

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