Massachusetts Health Insurance

Massachusetts (MA)

Individual Health Insurance Regulations

Medical insurance is necessary to protect your family's health against unfortunate circumstances of sickness or injury. Before opting for health coverage, you need to assess through your family's medical needs and your budget. Being a Massachusetts resident, you can choose from various product alternatives. The Massachusetts Division of Insurance supervises the regulations under which the Massachusetts health insurers can sell private healthcare insurance to individuals and families.We offer free access to quotes for individuals, families and groups in the state of Massachusetts. The information and resource links provided below are designed to help you learn more about finding affordable medical insurance in your state.
Search for plans and the costs associated with them using the search box above. We provide individual, family, Medicare supplemental, group and student health plan quotes for you to compare on all states and zip codes. Remember that having coverage leads to a healthier lifestyle as you are able to get regular doctor checkups and therefore a low-cost premium.

Massachusetts (MA)

Small Group Health Insurance Regulations

A small group is defined as a group of employees between 1 and 50 for it to qualify as such. A full-time "equivalent" employee is defined as an individual who works 35 hours or more per week at a Massachusetts location (even if they live in another state). However, independent contractors, seasonal employees, temporary employees or workers from temp agencies still be eligible for insurance coverage at the employer's discretion. The insurance Carriers will normally define a full time employee as one who works 30 hours per week. While an employer may be able to offer coverage to employees who work less than 30 hours per week, eligibility is set at 30 hours as a minimum requirement. Small group medical insurance in Massachusetts is issued on a guaranteed issue basis, meaning that no group can be denied coverage as a result of their overall health history. Under an employer-sponsored group health plan, employers may require employees to incur a waiting period before becoming eligible to apply for coverage under the group health plan. Applicants not able to provide proof of prior creditable coverage may be subjected to a 6 month pre-existing condition exclusionary period by the insurance carrier after reviewing their 6-month health history. Group rates in Massachusetts are community based and may vary in accordance with age, industry, group size, geography, family composition and group participation percentages. Discounted rates are available to groups that participate in wellness programs.
Employers with one or more full-time employees may establish a group plan with employer contributions so long as the premium contribution towards full-time non-bargaining employees (defined by the state as working 35 hours or more) is not discriminatory. An employer may also establish a Section 125 plan for employees who are not eligible for their group plan and allow them to purchase insurance through the Commonwealth Connector.

Employers with 11 or more full-time equivalent employees have four requirements:

  • You must offer a Section 125 cafeteria plan that meets Commonwealth Connector regulations. If you don't offer a Section 125 cafeteria plan, you will pay the Free Rider Surcharge if your employees or their dependents get medical care that is paid by the state's Free Care Pool- now called the Health Safety Net -for the uninsured;

  • You must make a "fair and reasonable" contribution to your employees' medical insurance or pay a Fair Share Contribution or fine of up to $295 per employee per year.

  • A "fair and reasonable" contribution by an employer is:

    • 25% of an employer's full-time employees are participating in the employer's group health plan or

    • An employer's contribution of at least 33% toward a health plan premium for all full-time employees who are employed for more than 90 days.

  • Employers must complete an Employer Health Insurance Responsibility Disclosure (HIRD) Form/Report which must be filed on-line, to report if you offer a Section 125 Plan that complies with Commonwealth Connector regulations;

  • Employers must collect an HIRD Employee Form from employees who decline your employer sponsored coverage and/or your employer sponsored Section 125 Plan.

New Jersey COBRA and Continuation Coverage

Groups with 20 or more employees must follow federal COBRA regulations which state that a departing employee is entitled to remain on the group health plan for a period of 18 months, provided that group health plan remains in existence. An employee who has left work on his own or was terminated from the job is eligible to be covered by COBRA. The one exception to this is if the former employer was fired for gross misconduct. COBRA provides health coverage to individuals and their beneficiaries, spouses and dependents. The COBRA recipient will be responsible for the payment of the entire the insurance premium that the employer was paying for his coverage as well as 2% administrative costs.
New Jersey has its own state mini-COBRA regulation enacted through Regulation Chapter 17B, Section 27-60 which applies to small group health plans within the state. COBRA is a continuation of coverage under the small group health plan, which may be elected upon the occurrence of a specific qualifying event. This allows the employee to remain on the group health plan and receive the same level of coverage for a specific period of time. Under New Jersey law, the period of time you may remain on the plan is dependent upon the qualifying event, with maximums of 18, 29 and 36 months. Election for continuation coverage must be made in writing within 30 days of the qualifying event and must be made available to any employee that has had a reduction in hours to less than 25, or has lost their job for a reason other than just cause. New Jersey does not have a conversion option for persons leaving a group health plan because New Jersey is a guaranteed issue state for the individual health market.