Session Laws

Whereas, The deferred operation of this act would tend to defeat its purpose, which is to immediately increase the affordability of health insurance in the commonwealth, therefore it is hereby declared to be an emergency law, necessary for the immediate preservation of the public convenience.

Be it enacted by the Senate and House of Representatives in General Court assembled, and by the authority of the same, as follows:

SECTION 1. Subsection (a) of section 5 of chapter 176J of the General Laws, as appearing in the 1994 Official Edition, is hereby amended by striking out, in line 2, the words "an actual or expected health condition" and inserting in place thereof the following words:- age, occupation, actual or expected health condition, claims experience, duration of coverage, or medical condition of such person.

SECTION 2. Section 7 of said chapter 176J is hereby amended by striking out, in line 3, as appearing in section 27 of chapter 297 of the acts of 1996, the words "who purchase a health benefit plan from the carrier" and inserting in place thereof the following words:- enrolled in a health benefit plan offered by the carrier.

SECTION 3. Section 1 of chapter 176M of the General Laws, as appearing in section 29 of said chapter 297, is hereby amended by inserting after the definition of "Actuarial opinion" the following definition:-

"Adjusted composite rate", the composite rate for each guaranteed issue health plan issued by a carrier adjusted in a consistent manner to be prescribed by the commissioner by regulation to account for differences in premiums between carriers that are the result of (i) geographic differences in the cost of health care, (ii) the average age of eligible individuals enrolled in a carrier's guaranteed issue health plan; and (iii) differences in benefit levels as permitted by subsection (d) of section two.

SECTION 4. Said section 1 of said chapter 176M, as so appearing, is hereby further amended by striking out the definition of "Carrier" and inserting in place thereof the following definition:-

"Carrier", an insurer licensed or otherwise authorized to transact accident and health insurance under chapter one hundred and seventy-five or the laws of any other jurisdiction; a nonprofit hospital service corporation organized under chapter one hundred and seventy-six A or the laws of any other jurisdiction, a nonprofit medical service corporation organized under chapter one hundred and seventy-six B or the laws of any other jurisdiction; a health maintenance organization organized under chapter one hundred and seventy-six G or the laws of any other jurisdiction; and an insured health plan that includes a preferred provider arrangement organized under chapter one hundred and seventy-six I or the laws of any other jurisdiction. For the purposes of this chapter, carriers that are affiliated companies shall be treated as one carrier; provided, however, that a carrier shall offer a guaranteed issue health plan in every geographic area served by one or more of its affiliates. Joint marketing ventures between carriers shall not constitute an affiliation.

SECTION 5. Said section 1 of said chapter 176M, as so appearing, is hereby further amended by striking out the definition of "Closed plan" and inserting in place thereof the following definition:-

"Closed plan", a nongroup health plan issued by a carrier to a natural person for said person, as well as any covered dependents, prior to the first day of the first open enrollment period specified in subsection (b) of section three. A carrier may permit a natural person to continue to add new dependents to a policy issued under a closed plan.

SECTION 6. Said section 1 of said chapter 176M, as so appearing, is hereby further amended by striking out the definition of "Conversion nongroup health plan" and inserting in place thereof the following definition:-

"Conversion nongroup health plan", a nongroup health plan, offered, sold, issued, delivered, made effective or renewed by a carrier to a former employee or member or the dependents, including a spouse of said former employee or member, within or without the commonwealth pursuant to the terms of a group policy, contract or agreement with said former employee's former employer, or through a trust or association; provided, however, that this definition shall not include a group policy, contract, or agreement issued to any natural person eligible for continued group coverage under section four thousand nine hundred and eighty B of the Internal Revenue Code of 1986, as amended, under sections six hundred and one to six hundred and eight, inclusive, of the Employee Retirement Income Security Act of 1974, as amended, under sections two thousand two hundred and one to two thousand two hundred and eight, inclusive, of the Public Health Service Act, as amended, or under section nine of chapter one hundred and seventy-six J.

SECTION 7. Said section 1 of said chapter 176M, as so appearing, is hereby further amended by striking out the definition of "Guaranteed issue managed care plan" and inserting in place thereof the following definition:-

"Guaranteed issue managed care plan", a nongroup health plan, including a conversion nongroup health plan, sold, issued, delivered, made effective or renewed by a carrier, within or without the commonwealth pursuant to chapter one hundred and seventy-six G or the laws of any other jurisdiction, to any eligible individual for said individual or his eligible dependents regardless of age, occupation, actual or expected health condition, claims experience, duration of coverage or medical condition of such person, subject to the exclusions set forth in this chapter, that provides the benefits specified in subsection (c) of section two. A carrier may establish no more than one guaranteed issue managed care plan.

SECTION 8. Said section 1 of said chapter 176M, as so appearing, is hereby further amended by striking out the definition of "Guaranteed issue medical plan" and inserting in place thereof the following definition:-

"Guaranteed issue medical plan", a nongroup health plan, including a conversion nongroup health plan, sold, issued, delivered, made effective or renewed within or without the commonwealth by a carrier pursuant to either chapter one hundred and seventy-five, one hundred and seventy-six A or chapter one hundred and seventy-six B or the laws of any other jurisdiction to any eligible individual for said individual or his or her eligible dependents regardless of age, occupation, actual or expected health condition, claims experience, duration of coverage or medical condition of such person, subject to the limitations set forth in this chapter, that provides the benefits specified in subsection (c) of section two. A carrier may establish no more than one guaranteed issue medical plan.

SECTION 9. Said section 1 of said chapter 176M, as so appearing, is hereby further amended by striking out the definition of "health plan" and inserting in place thereof the following definition:-

"Health plan", any individual, general, blanket, or group policy of health, accident or sickness insurance issued by an insurer licensed under chapter one hundred and seventy-five or the laws of any other jurisdiction; a hospital service plan issued by a nonprofit hospital service corporation pursuant to chapter one hundred and seventy-six A or the laws of any other jurisdiction; a medical service plan issued by a nonprofit hospital service corporation pursuant to chapter one hundred and seventy-six B or the laws of any other jurisdiction; a health maintenance contract issued by a health maintenance organization pursuant to chapter one hundred and seventy-six G or the laws of any other jurisdiction; and an insured health benefit plan that includes a preferred provider arrangement issued pursuant to chapter one hundred and seventy-six I or the laws of any other jurisdiction. The words "health plan" shall not include accident only, credit or dental insurance, hospital indemnity insurance policies which for the purposes of this chapter shall mean policies issued pursuant to chapter one hundred and seventy-five which provide a benefit not to exceed two hundred and fifty dollars per day, as adjusted on an annual basis by the amount of increase in the average weekly wage in the commonwealth as defined in chapter one hundred and fifty-two, to be paid to an insured or a dependent, including the spouse of an insured, on the basis of a hospitalization of the insured or a dependent or disability income insurance issued as a supplement to liability insurance, insurance arising out of a worker's compensation law or similar law, automobile medical payment insurance, insurance under which benefits are payable with or without regard to fault and which is statutorily required to be contained in a liability insurance policy or equivalent self insurance, long term care only insurance, or any policy subject to the provisions of chapter one hundred and seventy-six K. The commissioner may by regulation define other health coverage as a health plan for the purposes of this chapter.

SECTION 10. Said section 1 of said chapter 176M, as so appearing, is hereby further amended by striking out the definition of "Guaranteed issue preferred provider plan" and inserting in place thereof the following definition:-

"Guaranteed issue preferred provider plan", a nongroup health plan, including a conversion nongroup health plan, sold, issued, delivered, made effective or renewed within or without the commonwealth by a carrier pursuant to chapter one hundred and seventy-six I or the laws of any other jurisdiction to any eligible individual for said individual or his eligible dependents regardless of age, occupation, actual or expected health condition, claims experience, duration of coverage or medical condition of such person, subject to the limitations set forth in this chapter, that provides the benefits set forth in subsection (c) of section two. A carrier may establish no more than one guaranteed issue preferred provider plan.

SECTION 11. The definition of "Nongroup health plan" of said section 1 of said chapter 176M, as so appearing, is hereby amended by adding the following sentence:- The term nongroup health plan shall not include a health benefit plan issued or renewed to a natural person pursuant to chapter one hundred and seventy-six J.

SECTION 12. Said section 1 of said chapter 176M, as so appearing, is hereby further amended by striking out the definition of "Qualifying health plan".

SECTION 13. Said section 1 of said chapter 176M, as so appearing, is hereby further amended by striking out the definition of "Rating factor" and inserting in place thereof the following definition:-

"Rating factor", characteristics including, but not limited to age, occupation, sex, geography, actual or expected health condition, medical history, claims history, or duration of coverage.

SECTION 14. Section 2 of said chapter 176M, as so appearing, is hereby amended by striking out subsections (a) and (b) and inserting in place thereof the following two subsections:-

(a) Any nongroup health plan offered, sold, issued, delivered, made effective, or renewed by any carrier on or after August fifteenth, nineteen hundred and ninety-six shall comply with the provisions of this chapter; provided, however, that the offer, sale, issue, renewal or delivery of a conversion nongroup health plan shall not obligate the carrier to otherwise offer, sell, issue, renew or deliver a nongroup health plan to any person to whom it does not have such an obligation pursuant to a group policy, contract or agreement with an employer or through a trust or association; provided, however, that a conversion nongroup health plan shall be subject to all other requirements of this chapter.

(b)(1) As a condition of doing business in the commonwealth, a carrier that offers health benefit plans to qualified small businesses, as defined by chapter one hundred and seventy-six J, shall participate in the nongroup health insurance market. A carrier shall be exempt from this requirement if, as of the close of the preceding calendar year, the combined total of eligible employees and eligible dependents, as defined by chapter one hundred and seventy-six J, enrolled in health benefit plans offered by it to qualified small businesses does not exceed five thousand individuals.

(2) A carrier that, as of the close of the preceding calendar year, has a combined total of five thousand or more eligible employees and eligible dependents, as defined by chapter one hundred and seventy-six J, who are residents of the commonwealth and who are enrolled in health benefit plans sold, issued, delivered, made effective or renewed to qualified small businesses pursuant to its license under chapter one hundred and seventy-six G, shall be considered to be participating in the nongroup health insurance market only if it offers for sale, issue, delivery, effectuation or renewal to any eligible individual a guaranteed issue managed care plan, subject to the exceptions set forth in this chapter.

(3) A carrier that, as of the close of the preceding calendar year, has a combined total of five thousand or more eligible employees and eligible dependents, as defined by chapter one hundred and seventy-six J, who are residents of the commonwealth and who are enrolled in health benefit plans sold, issued, delivered, made effective or renewed to qualified small businesses pursuant to its license or licenses under chapter one hundred and seventy-five, chapter one hundred and seventy-six A or chapter one hundred and seventy-six B, shall be considered to be participating in the nongroup health insurance market only if it offers for sale, issue, delivery, effectuation or renewal to any eligible individual a guaranteed issue medical plan, subject to the exceptions set forth in this chapter. For the purposes of this section, neither an eligible employee, nor an eligible dependent, shall be considered to be enrolled in a health benefit plan issued pursuant to a carrier's license under chapter one hundred and seventy-five if said health benefit plan is sold, issued, delivered, made effective or renewed to said eligible employee or eligible dependent as a supplement to a health benefit plan subject to licensure under chapter one hundred and seventy-six G.

(4) A carrier that is required, pursuant to subsection (3), to offer for sale to any eligible individual a guaranteed issue medical plan may instead offer for sale, issue, delivery, effectuation or renewal to any eligible individual a guaranteed issue preferred provider plan, subject to the exceptions set forth in this chapter; provided, however, that nothing in this chapter shall prohibit a carrier from offering both a guaranteed issue medical plan and a guaranteed issue preferred provider plan should it so choose.

SECTION 15. Paragraph (1) of subsection (c) of said section 2 of said chapter 176M, as so appearing, is hereby amended by striking out the first sentence and inserting in place thereof the following sentence:- Said contractors shall develop recommendations consistent with this section relative to the benefits to be provided by, and the cost sharing requirements of, the standard guaranteed issue managed care plan, the standard guaranteed issue medical plan, and the standard guaranteed issue preferred provider plan.

SECTION 16. Said subsection (c) of said section 2 of said chapter 176M, as so appearing, is hereby further amended by striking out paragraph (2) and inserting in place thereof the following paragraph:-

(2) After due consideration of the recommendations of the contractors, and no later than fourteen days after the submission of said recommendations, said board shall make final recommendations, upon which a majority of the members shall agree and which are consistent with the standards established in paragraph (1), to the commissioner relative to the benefits to be provided by, and the cost sharing requirements of, the standard guaranteed issue health plans. The commissioner shall, no later than fourteen days after the submission of the board's recommendations, either approve or disapprove said recommendations. The commissioner shall not modify the recommendations of said board. If the commissioner does not approve the recommendations of said board, said board shall, after consulting with the contractors, submit new recommendations, upon which a majority of the members agree and which are consistent with the standards established in said paragraph (1), to the commissioner no later than fourteen days following his decision to disapprove the standard benefit plans.

SECTION 17. Said subsection (c) of said section 2 of said chapter 176M, as so appearing, is hereby further amended by striking out paragraphs (5) and (6).

SECTION 18. Section 3 of said chapter 176M, as so appearing, is hereby amended by striking out subsection (a) and inserting in place thereof the following subsection:-

(a) No carrier shall exclude any eligible individual or eligible dependent on the basis of age, occupation, actual or expected health condition, claims experience, duration of coverage, or medical condition of such person, nor impose any pre-existing condition provision or waiting period in any guaranteed issue health plan.

SECTION 19. Subsection (b) of said section 3 of said chapter 176M, as so appearing, is hereby amended by striking out the first sentence and inserting in place thereof the following sentence:- In calendar year nineteen hundred and ninety-seven, the carrier shall enroll eligible individuals into guaranteed issue health plans during an open enrollment period commencing June first and ending July thirty-first with coverage to become effective September first.

SECTION 20. Said section 3 of said chapter 176M, as so appearing, is hereby further amended by adding the following five subsections:-

(d) As of the first day of the first open enrollment period specified in subsection (b), no carrier shall issue a health plan to an eligible individual other than a guaranteed issue health plan; provided, however, that a carrier may renew a closed plan for a period of no more than three years. A carrier shall file its rates for a closed plan in accordance with subsection (a) of section five. A closed plan shall not otherwise be subject to the requirements of section five. A closed plan shall not be subject to the requirements of section four. No carrier shall, during the allowable renewal period for a closed plan, add any new rating factor to the rating methodology which was applicable to its closed plan as of August fifteenth, nineteen hundred and ninety-six. A carrier shall permit a subscriber of a closed plan to enroll in a guaranteed issue health plan at any time during the allowable three year renewal period. All carriers with closed plans shall, pursuant to their underwriting guidelines, continue to enroll individuals into said closed plans until the first day of the first open enrollment period specified in subsection (b).

(e) No carrier shall knowingly issue a guaranteed issue health plan to any individual other than an eligible individual. A carrier may renew a nongroup health plan previously issued to an individual who is not an eligible individual only if said individual either was insured under said plan as of August fifteenth, nineteen hundred and ninety-six or was insured as of August fifteenth, nineteen hundred and ninety-six under a nongroup health plan issued by said carrier and said plan is no longer offered by the carrier.

(f) A carrier shall not be required to issue or renew a guaranteed issue health plan to any eligible individual if the carrier can demonstrate any of the following (1) that the acceptance of applications would create for the carrier a condition of financial impairment, and the carrier demonstrates the same to the commissioner; (2) that the eligible individual does not meet a health maintenance organization's requirements regarding residence or employment within the health maintenance organization's approved service area; or (3) that within an area, where the health maintenance organization reasonably anticipates, and demonstrates to the satisfaction of the commissioner, that it will not, within that area, have the capacity in its network of providers to deliver services adequately to the individual because of its obligation to existing contract holders and enrollees; provided, however, that such a health maintenance organization shall not offer coverage in the applicable area to any new applicants for coverage, whether they be applicants for group or nongroup coverage, until the later of ninety days after each such refusal or the date on which the health maintenance organization notifies the commissioner that it has regained capacity to deliver services to eligible individuals.

(g) A carrier shall not be required to issue or renew a guaranteed issue health plan to an eligible individual, and may cancel a previously issued guaranteed issue health plan, if (1) the individual failed to pay the required premium for any health benefit plan on a timely basis, (2) the individual committed fraud or misrepresented whether he qualifies as an eligible individual, (3) the individual failed to comply in a material way with the provisions of the health benefit plan, the member contract, or the subscriber agreement, or (f) the individual failed to comply with the carrier's reasonable request for information in accordance with subsection (d) of section four in the application for coverage under a guaranteed issue health plan. A premium shall be considered to have been paid on a timely basis if it is paid within sixty days.

(h) A carrier that decides to terminate coverage for all eligible individuals enrolled in a specific guaranteed issue health benefit plan shall notify the commissioner no later than ninety days prior to the beginning of the next open enrollment period that it is terminating coverage under that guaranteed issue health benefit plan and that it will not participate in the upcoming open enrollment period with respect to that plan. Such carrier shall continue to provide coverage until ninety days after the conclusion of the said open enrollment period or until all of such carrier's enrollees in that guaranteed issue health plan are transferred to another carrier providing guaranteed issue health plans to eligible individuals, whichever occurs first. A carrier may not terminate a guaranteed issue health plan if such termination would cause the carrier to violate subsection (b) of section two. A carrier who terminates guaranteed issue health plans pursuant to this subsection shall not issue any guaranteed issue health benefit plans pursuant to this subsection for a period of five years; provided, however, that the commissioner, in his discretion, may allow a carrier to re-enter the nongroup market sooner.

SECTION 21. Subsection (a) of section 4 of said chapter 176M, as so appearing, is hereby amended by striking out paragraph (1) and inserting in place thereof the following paragraph:-

(1) Each carrier shall establish a base premium rate for each rate basis type within each guaranteed issue health plan it offers. The premium charged to any eligible purchaser shall be limited to the base premium rate multiplied by the factors specified in paragraphs (2) and (3).

SECTION 22. Paragraph (2) of said subsection (a) of said section 4 of said chapter 176M, as so appearing, is hereby amended by striking out the first sentence and inserting in place thereof the following sentence:- A carrier may establish a premium rate adjustment based upon the age of an insured individual.

SECTION 23. Said paragraph (2) of said subsection (a) of said section 4 of said chapter 176M, as so appearing, is hereby further amended by striking out the third, fourth and fifth sentences and inserting in place thereof the following two sentences:- Between December first, nineteen hundred and ninety-six and November thirtieth, nineteen hundred and ninety-nine, a carrier may establish an age rate adjustment, the value of which may range from sixty-seven one-hundredths to one hundred and thirty-three one-hundredths. Effective December first, nineteen hundred and ninety-nine, the value of the age rate adjustment established by a carrier may range from eighty one-hundredths to one hundred and twenty one-hundredths.

SECTION 24. Said subsection (a) of said section 4 of said chapter 176M, as so appearing, is hereby further amended by striking out paragraph (4) and inserting in place thereof the following paragraph:-

(4) The premium rate charged by a carrier to each individual on the date of the individual's guaranteed issue health policy is issued or renewed shall be the base premium rate charged for that rate basis type, multiplied by the age rate adjustment, multiplied by the area rate adjustment, as may be applicable pursuant to this section.

SECTION 25. Said section 4 of said chapter 176M, as so appearing, is hereby further amended by striking out subsections (b), (c), (d) and (e).

SECTION 26. Section 5 of said chapter 176M, as so appearing, is hereby amended by striking out subsection (a) and inserting in place thereof the following subsection:-

(a)(1) No later than seventy-five days after the commissioner has approved the standard benefits plans pursuant to section two and no later than May first of each year thereafter, each carrier shall submit a nongroup rate filing to the commissioner. Each carrier shall also submit a copy of its nongroup rate filing to the nongroup health insurance advisory board. The board may include information from nongroup rate filings in its annual consumer's guide.

(2) Nongroup rate filings shall contain the following information:

(i) the base premium rate to be charged within each rate basis type for each guaranteed issue health plan and for each closed plan;

(ii) the age and geographic adjustments to be charged within each rate basis type for each guaranteed issue health plan and for each closed plan;

(iii) the composite rate for each guaranteed issue health plan;

(iv) the adjusted composite rate for each guaranteed issue health plan and documentation reasonably necessary to substantiate the adjustments made;

(v) a memorandum signed by an actuary certifying that the rates for each guaranteed issue health plan have been developed in accordance with section four, including the rate bands and multipliers specified therein and that the proposed rates are reasonable in relation to the benefits provided;

(vi) for each guaranteed issue health plan and each closed plan, the actual loss ratio for the previous year and the projected loss ratios for the present year and the year for which the rate is being filed. Loss ratio shall be defined as the ratio of the incurred costs for hospital, medical or health care services for the relevant period to the premium earned for that same period;

(vii) a comparison of current and proposed rates for each guaranteed issue health plan which shows premium cost components, including but not limited to the cost of prescription drugs administered on an outpatient basis, stated as a percentage of premium;

(viii) a copy of its annual report; and

(ix) for the filing in calendar year nineteen hundred and ninety-seven only, the total number of insured, the total number of policies issued, the total number of policies issued within each rate basis type, and the rates charged for each closed plan offered by the carrier as of August fifteenth, nineteen hundred and ninety-six.

SECTION 27. Subsection (b) of said section 5 of said chapter 176M, as so appearing, is hereby amended by striking out the first two sentences and inserting in place thereof the following two sentences:- No later than forty-five days after carriers are required to submit their nongroup rate filings, the commissioner shall determine the average adjusted composite rate for each type of guaranteed issue health plan. The commissioner shall determine whether the adjusted composite rate filed by each carrier exceeds the average adjusted composite rate for that type of guaranteed issue health plan by more than two standard deviations.

SECTION 28. Said subsection (b) of said section 5 of said chapter 176M, as so appearing, is hereby further amended by striking out the fifth and sixth sentences and inserting in place thereof the following two sentences:- The commissioner shall also examine the design of the benefits of each guaranteed issue health plan to determine if it complies with applicable laws and regulations and to determine whether its design may have the effect of minimizing the number of eligible individuals who will enroll in said plan. The commissioner shall also determine the average rate of closed plans in effect as of August fifteenth, nineteen hundred and ninety-six.

SECTION 29. Subsection (e) of said section 5 of said chapter 176M, as so appearing, is hereby amended by striking out the second sentence and inserting in place thereof the following sentence:- The case mix adjustment shall be based upon the diagnosis related group grouper selected by the division of health care finance and policy established under chapter one hundred and eighteen G and associated diagnosis related group weights calculated from Massachusetts data, and shall measure the differential case mix compared to the case mix of all privately insured persons discharged from hospitals from the commonwealth, as determined by said division of health care finance and policy.

SECTION 30. Section 6 of said chapter 176M, as so appearing, is hereby amended by striking out the second sentence and inserting in place thereof the following sentence:- Any carrier issuing guaranteed issue health plans may be a member of said plan; provided, however, that no carrier shall be required to be a member of said plan.

SECTION 31. The definition of "Health plan" in section 1 of chapter 176N of the General Laws, as appearing in section 30 of said chapter 297, is hereby amended by striking out the last sentence and inserting in place thereof the following sentence:- This definition shall not include accident only, credit or dental insurance, hospital indemnity insurance policies which for the purposes of this chapter shall mean policies issued pursuant to chapter one hundred and seventy-five which provide a benefit not to exceed two hundred and fifty dollars per day, as adjusted on an annual basis by the amount of increase in the average weekly wage in the commonwealth as defined in chapter one hundred and fifty-two, to be paid to an insured or a dependent, including the spouse of an insured, on the basis of a hospitalization of the insured or a dependent disability income insurance, coverage issued as a supplement to liability insurance, insurance arising out of a worker's compensation or similar law, automobile medical payment insurance, insurance under which benefits are payable with or without regard to fault and which is statutorily required to be contained in a liability insurance policy or equivalent self-insurance, long term care only insurance, or any group blanket or general policy which provides supplemental coverage to Medicare or other governmental programs.

SECTION 32. Said section 1 of said chapter 176N, as so appearing, is hereby amended by striking out the definition of "Out of state health plan" and inserting in place thereof the following definition:-

"Out of state health plan", any general, blanket, group or nongroup policy of health, accident and sickness insurance issued by an insurer meeting the requirements for licensure under chapter one hundred and seventy-five or the laws of any other jurisdiction; a group hospital service plan issued by a nonprofit hospital service corporation under chapter one hundred and seventy-six A or the laws of any other jurisdiction; a group medical service plan issued by a nonprofit hospital service corporation under chapter one hundred and seventy-six B or the laws of any other jurisdiction; a group health maintenance contract issued by a health maintenance organization meeting the requirements for licensure under chapter one hundred and seventy-six G or the laws of any other jurisdiction; or a preferred provider arrangement meeting the requirements for licensing under chapter one hundred and seventy-six I or the laws of any other jurisdiction which (i) is delivered or issued for delivery outside the commonwealth and (ii) covers any resident of the commonwealth.

SECTION 33. Section 2 of said chapter 176N, as so appearing, is hereby amended by striking out clause (a) and inserting in place thereof the following clause:-

(a) exclude any eligible insured on the basis of age, occupation, actual or expected health condition, claims experience, duration of coverage, or medical condition of such person.

SECTION 34. Subsection (c) of said section 2 of said chapter 176N, as so appearing, is hereby amended by inserting after the second sentence the following sentence:- The waiting period may only apply to services which the new plan covers, but which were not covered under the old plan.

SECTION 35. Section 31 of chapter 297 of the acts of 1996 is hereby amended by adding the following two paragraphs:-

Between June fifteenth, nineteen hundred and ninety-nine and December thirtieth, nineteen hundred and ninety-nine, said board established under this section shall review whether the hearing and review process prescribed by chapter one hundred and seventy-six M of the General Laws to determine whether said hearing and review process has served the public interest and constituted an efficient and effective use of public and private resources. The board shall submit to the general court a report containing its findings.

Between January first, two thousand and one and April first, two thousand and one, said board established under this section shall undertake a study of premium rates for nongroup health insurance as of August fifteenth, nineteen hundred and ninety-six in reference to the indicators it establishes pursuant to this section which may include the average premium reported by the commissioner pursuant to section five of chapter one hundred and seventy-six M, adjusted for Massachusetts specific medical inflation as determined by DRI-McGraw Hill, Inc. The board shall issue a report of its findings and the overall status of the nongroup health insurance market and shall make pertinent recommendations to the joint committee on insurance.