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Back to State Legislation on Comprehensive Health Care Coverage

Background

Coverage

Under the Act, state residents must obtain coverage that meets Minimum Creditable Coverage (MCC) requirements.  MCC means a plan that offers:

  • Coverage of certain medical services
  • Preventative care doctor visits
  • An annual deductible cap of $2,000 for individuals and $4,000 for a family
  • A cap on “out-of-pocket spending for non-Rx health services” at $5,000 for a family and $10,000 for a family
  • No cap on total benefits to cover an illness, Mass. Gen. Laws ch. 111M § 1 & 956 Mass. Code Regs. 5.01 - 5.05 (external link) (PDF).

Employer Contribution

  • Employers who employ 11 or more full time equivalent employees and do not provide them with health insurance pay a “Fair Share Employer Contribution.”  Mass. Gen. Laws ch. 149 § 188.
  • Employers not paying the "Fair Share Employer Contribution" are required to pay a “Free Rider Surcharge” if they have 11 or more employees, are not providing health coverage to their employees, and those employees obtain free state coverage. Mass. Gen. Laws ch. 118G § 18b.
  • Employers with 11 or more employees are required to offer cafeteria employee benefit plans that meet certain legal requirements.  Mass. Gen. Laws ch.151F § 2.

Individual Contribution

  • State residents over the age of 18 must obtain and maintain “creditable coverage.”  Residents must designate on their tax returns what coverage they have in force. Mass. Gen. Laws ch.111M § 2.
  • Commonwealth residents without coverage can be penalized by state retention of tax overpayment in the amount of up to “50 per cent of the minimum insurance premium for creditable coverage available through the commonwealth health insurance connector for which the individual would have qualified during the previous year.” Mass. Gen. Laws ch.111M § 2.

Benefits Assistance

Exemptions

For more information on Massachusetts see:

Last Updated: 02/28/2014