Decreto reglamentario 2664 de 1994

In addition, we studied a number of other sites that provide similar information, shopping experiences and tools, some of which are listed here:

• Aetna – http://www.aetna.com/members/individuals/index.html and

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• Blue Cross Blue Shield of Massachusetts –

http://www.bluecrossma.com/common/en_US/healthPlansIndex.jsp?headerRepId=Repositories.HeaderButtons. healthPlans.xml&levelOneCategory=GENERAL&targetTemplate=titleBody.jsp

• Health Care for All – http://www.hcfama.org/index.cfm?fuseaction=Page.viewPage&pageId=588 (specific to Commonwealth Care)

• Health Insurance Finders - http://www.healthinsurancefinders.com/ • Insureco.org – https://secure.insureco.org/

• Most Choice – http://www.mostchoice.com/global/app_forms/pers_decide_c.cfm • Quick Quote - http://www.quickquote.com/

• Pacific source health plans - http://www.pacificsource.com/our_plansIF.html • United HealthCare – http://www.uhc.com/ (uses eHealthInsurance.com)

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14.3 Glossary

Term Definition

Chapter 58 In April 2006, Massachusetts enacted Chapter 58 of the Acts of 2006, “An act providing access to affordable, quality, accountable Health Care” (aka Health Care Reform), as part of Massachusetts General Law designed to eliminate the high costs created by uninsured and underinsured individuals within the Commonwealth.

Commonwealth Care Connector program that provides options for comprehensive health care to qualified individuals and families with income at or below 300% of the Federal Poverty Level who would otherwise not have access to affordable insurance. Coverage is provided through four approved Medicaid Managed Care Organizations, with limited customer choice of carrier and benefit level. Commonwealth Choice Connector program that offers an array of approved health plans primarily to

individuals and small employers (< 50 employees). Coverage is offered through quality health insurance carriers already licensed in Massachusetts. Customers can choose among carriers and three different levels of benefits & premiums (premier, value, and minimum creditable), with special plans designed specifically for young adults not requiring more comprehensive coverage due to their relative health status.

Connector The Commonwealth Health Insurance Connector Authority is an independent authority created under Chapter 58 of the Acts of 2006 to implement the act’s provisions by serving as a bridge between uninsured individuals and small employers, and the health plans qualified to offer them quality, affordable health insurance coverage.

Employer mandate Provisions of health care reform (enabled by Chapter 58) that require employers with 11+ FTEs to make a “fair and reasonable contribution” to health coverage. Definition of what constitutes a “fair and reasonable contribution” was left to the Connector. Employers who do not make a qualifying contribution will be assessed an amount not to exceed $295/employee/year.

Enrollment Processes related to collecting and accepting individual, employer, and employee application and enrollment forms; verifying that enrollment forms are complete and correct; verifying individual, employer, and employee eligibility; processing applications; and transmitting appropriate eligibility and enrollment information to participating health plans.

Federal Poverty Level (FPL) The minimum amount of income that a family needs for food, clothing, transportation, shelter and other necessities, as determined by the Department of Health and Human Services. FPL varies according to family size. The number is adjusted for inflation and reported annually in the form of poverty guidelines. Many public assistance programs, including Medicaid and Commonwealth Care, define eligibility income limits as some percentage of FPL. Information and current levels are available at http://aspe.hhs.gov/poverty/07poverty.shtml . Health care reform The provisions of Chapter 58 of the Acts of 2006 being implemented by the

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Term Definition

Individual mandate Provisions of health care reform (enabled by Chapter 58) that require all Massachusetts residents to acquire and show proof of minimum creditable health insurance coverage beginning July 1, 2007. Definition of what constitutes a minimum creditable coverage was left to the Connector. Minimum creditable coverage The lowest level of health insurance coverage deemed adequate to meet the

requirements of individual mandate by protecting beneficiaries from catastrophic costs, promoting access to routine preventive care, balancing premium affordability with potential out-of-pocket costs, encouraging preventive care, and covering core medical services

MMCO Medicaid Managed Care Organization. Private health maintenance organization (HMO) contracted with a state Medicaid program to manage the risk and administer a portion of the Medicaid population or provide other health-related public assistance coverage. Four MMCOs have been awarded three year exclusivity to administer Commonwealth Care – BMC HealthNet, Fallon Community Health Plan, Neighborhood Health Plan, and Network Health. Pre-enrollment Customer service and other activities that occur before an individual submits an

application for coverage and first premium payment for health insurance. Premium conversion The process of individuals and employers taking a pre-tax deduction of health

insurance premium amounts, thereby reducing income before federal, state, and FICA taxes are calculated. This is allowed by tax law and has the affect of reducing taxes for individuals and employers alike.

Section 125 plan Section 125 of the Internal Revenue Code, enacted in 1978, allows companies to give their employees the opportunity to pay for benefits on a pre-tax basis, converting premium to a tax deduction for both the employer and employees. Section 125 offers several alternatives, the three most common being:

• Premium Only Plans: Employees pay premiums on a pre-tax basis through a mechanism such as the Connector, lowering their taxable income and tax liability.

• Flexible Spending Accounts: Employees pay for certain out-of-pocket health care or dependent care costs on a pre-tax basis.

• Cafeteria Plans: By contributing a “fair share” of premium, employers gain control over their benefit expenditures through a "cafeteria" or menu-like plan, to be implemented by the Connector by employers designating their own “benchmark plan”, limiting their employees to Commonwealth Choice health plans in that “tier” of offerings.

Sub-Connector A third-party contracted to provide a range of administrative services to the Connector for Commonwealth Choice and to serve as an intermediary between the Connector, health plans, and employers and individuals seeking coverage under Commonwealth Choice. Chapter 58 envisioned multiple Sub- Connectors. The Connector has decided to contract with a single entity for its initial implementation of Commonwealth Choice.

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14.4 References

The following is a complete list of all documents referenced elsewhere in this document:

i _{Uncompensated Care Pool PFY05 Annual Report, May 2006, Massachusetts Division of Health Care Finance and}

Policy, Boston, MA

ii

An Act promoting access to affordable, quality, accountable health care, Massachusetts General Laws, Boston, MA, Approved (in part) by the Governor, April 12, 2006 (http://www.mass.gov/legis/laws/seslaw06/sl060058.htm)

iii _{An Act relative to health care access, Massachusetts General Laws, Boston, MA, Approved by the Governor,}

October 26, 2006 (http://www.mass.gov/legis/laws/seslaw06/sl060324.htm)

iv

An Act further amending the health care access, Massachusetts General Laws, Boston, MA, Approved by the Governor, January 3, 2007 (http://www.mass.gov/legis/laws/seslaw06/sl060450.htm)

v

Health Care Access and Affordability Conference Committee Report, Massachusetts General Court, Boston, MA, April 3, 2006 (http://www.mass.gov/legis/summary.pdf)

©2007 Commonwealth Health Insurance Connector Authority Proprietary. www.mass.gov/connector 617-573-1600