Section 8H: Assessments; domestic insurers; actuary and assistant actuary; identification of medical assistance recipients
Section 8H. The commissioner of insurance is hereby authorized to make in each fiscal year an assessment against all domestic insurers and an assessment against nonprofit hospital, medical and dental service corporations as defined in section one of chapter one hundred and seventy-six A, section one of chapter one hundred and seventy-six B, and section one of chapter one hundred and seventy-six E. This assessment shall be to defray the salaries of an actuary and an assistant actuary appointed under this section to perform such duties as the commissioner of insurance may prescribe relating to life insurance, accident and sickness insurance and coverages provided under chapters one hundred and seventy-six A, one hundred and seventy-six B and one hundred and seventy-six E. The total assessment against domestic insurers shall be an amount, not to exceed seventy-five thousand dollars in any fiscal year, that the commissioner of insurance annually determines constitutes the expenses relating to such actuaries incurred with respect to duties performed relating to life and accident and sickness. The share of the total assessment for each domestic insurer shall be in proportion to such insurer's net premiums, after deducting therefrom all dividends paid, credited or applied, received during its fiscal year immediately preceding the assessment date from life and accident and sickness insurance business where the insured is a resident of the commonwealth at the time of payment of the premium. For the purposes of this section, ''domestic insurers'' shall include domestic companies as defined in section one of chapter one hundred and seventy-five which are authorized to transact all of the classes of insurance described in subdivisions (a) and (d) of clause sixth and in clause sixteenth of section forty-seven of chapter one hundred and seventy-five. The total assessment against nonprofit hospital, medical and dental service corporations shall be in an amount, not to exceed seventy-five thousand dollars in any fiscal year, that the commissioner of insurance annually determines constitutes the expenses relating to such actuaries incurred with respect to duties performed relating to matters concerning nonprofit hospital, medical and dental service corporations. The share of the total assessment for each nonprofit hospital, medical or dental service corporation shall be in proportion to such corporation's aggregate payments from subscribers received during its fiscal year immediately preceding the assessment date for business written in or in effect in the commonwealth.
The commissioner of insurance shall appoint the actuary and assistant actuary who shall devote their full time to the duties of their office and shall be exempt from the provisions of chapters thirty and thirty-one and shall serve at the pleasure of the commissioner. The actuary shall be a fellow or an associate of the Casualty Actuarial Society or the Society of Actuaries and the assistant actuary shall have successfully completed at least two examinations of one of the foregoing societies.
The division of insurance, in consultation with the commonwealth health insurance connector established by chapter 176Q, shall establish and publish minimum standards and guidelines at least annually for each type of health benefit plans, except qualified student health insurance plans as set forth in section 18 of chapter 15A, provided by insurers and health maintenance organizations doing business in the commonwealth.
The division of insurance is directed to require all health insurers and health maintenance organizations doing business in the commonwealth to identify persons who are recipients of medical assistance under chapter one hundred and eighteen E or recipients of health care services, including hospital and other services funded through the health safety net under chapter 118E, or who are responsible for supporting such recipients, and who are also beneficiaries under any policy for health insurance or parties to any health maintenance contract in force and effect in the commonwealth. The department of public welfare and the center for health information and analysis shall provide information to the extent sufficient to allow all insurers to identify such persons. Such information shall be made available by such insurers and health maintenance organizations and by the department and the center for health information and analysis only for the purposes of and to the extent necessary for identifying such persons. No health insurer or health maintenance organization which complies with this section shall be liable in any civil or criminal action or proceedings brought by such beneficiaries or members on account of such compliance. The division of insurance shall further direct all health insurers and health maintenance organizations doing business in the commonwealth to participate with the department and the center for health information and analysis in any procedures, including but not limited to automated file matches, conducted under the direction of the department and the center for health information and analysis for the purpose of identifying those persons who are recipients of medical assistance under chapter one hundred and eighteen E or recipients of health care services, including hospital and other services funded through the health safety net under chapter 118E, or who are responsible for supporting such recipients, and who are also beneficiaries under any policy for health insurance or parties to any health maintenance contract in force in the commonwealth. Participation in such a procedure by a health insurer or health maintenance organization doing business in the commonwealth shall include but not be limited to reasonable financial participation in the cost of any such procedure. The commissioner of insurance is authorized to promulgate regulations necessary to ensure the effectiveness of this section.