Employee Notice of Non-creditable Coverage for Massachusetts Residents by ktz54195

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									                                     Employee Notice of
                                  Non-creditable Coverage
                                for Massachusetts Residents
Date:        November 2008
Client Name: <Client Name>
Plan Name: <Plan Name>

As of January 1, 2009, the Massachusetts Health Care Reform Law requires that Massachusetts
residents, eighteen (18) years of age and older, must have health coverage that meets the Minimum
Creditable Coverage standards set by the Commonwealth Health Insurance Connector, unless waived
from the health insurance requirement based on affordability or individual hardship. For more information
call the Connector at 1-877-MA-ENROLL or visit the Connector website at www.mahealthconnector.org.

Based on our understanding of the Minimal Creditable Coverage standards set forth by the
Commonwealth Health Insurance Connector Authority (“the Connector”) and the specific guidance
provided to Health Plans, Inc. by the Connector staff, we have made the following assessment of the
coverage provided:

        ⌧     The Plan named above does not meet Minimum Creditable Coverage standards that
              are effective January 1, 2009, and will not satisfy the individual mandate that you
              have health insurance meeting the standards.

If you purchase this health plan only, you will not satisfy the statutory requirement that you have health
insurance meeting these standards.

Please note that if the Plan provisions are amended effective any time in 2009, this assessment could
change. You will be notified in the event of any Plan change.

If you have questions about your coverage under this Plan, please contact your Benefits or Human
Resources Department.

Here are the specific reasons why the Plan does not provide Minimum Creditable Coverage as specified
by the regulation:

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Reason Key
1.  There is an out-of-pocket maximum, but it does not include deductibles, coinsurance, and/or co-payments over
    $100 that apply to in-network covered services.
2a. Deductibles and coinsurance apply to core services,* but there is no out-of-pocket maximum.
2b. Deductibles and coinsurance apply to core services,* but are not included in the out-of-pocket maximum.
3. The deductible applies to preventive care.
4. The plan does not provide sufficient preventive care coverage.
5. The out-of-pocket maximum exceeds $5,000 per person and/or $10,000 per family annually.



                                                                                       Employee – Non-creditable
                                          Employee Notice of
                                       Non-creditable Coverage
                                     for Massachusetts Residents
6.    Deductibles exceed $2,000 per person and/or $4,000 per family annually.
7.    The Plan does not meet the federal requirements for an approved HDHP/HSA plan
8.    The plan does not provide maternity coverage for covered dependent children.
9.    Prescription drug deductibles exceed $250 per person and/or $500 per family annually.
10.   There is no prescription drug coverage.
11.   The Plan does not provide preventive care for all covered members.
12.   The Plan has an overall annual maximum.

*Under the regulation, core services are defined as: physician services, inpatient acute care, diagnostic testing and day surgery




                                                                                                       Employee – Non-creditable

								
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