Amendment #4 to H.3452

Consumer Protections through the Office of Patient Protection Waiver Process

Ms. Balser of Newton move that the bill be amended by adding the following section:

SECTION X. Subsection (a) of section 16 of chapter 6D of the General Laws is hereby amended by striking out paragraph (7) and inserting in place thereof the following paragraph:-

(7) administer and grant enrollment waivers under paragraph (4) of subsection (a) of section 4 of chapter 176J.

The office of patient protection may grant a waiver permitting a person to enroll in a health benefit plan outside of the annual open enrollment period if the office determines that:

(2)(i) the person is an eligible individual, as defined by section 1 of chapter 176J of the general laws, or an eligible individual as defined in section 2741 of the Health Insurance Portability and Accountability Act of 1996, 42 U.S.C. 300gg-41(b); and

(ii) the person experienced a qualifying event as defined in section 4 of chapter 176J of the general laws; or

(iii) the person experienced an event sufficiently similar to a qualifying event to warrant granting an enrollment waiver; or

(iv) the person experienced a qualifying event or event sufficiently similar to a qualifying event and applied after the expiration of the applicable time limit and the delay in application was unintentional or by no fault of the person; or

(v) the person certifies under penalty of perjury that the person did not intentionally forego enrollment into other health coverage for which the individual was eligible during a period of open enrollment; or

(vi) the person experienced extenuating circumstances that prevented such individual from enrolling in a health plan during the previous open enrollment period.

The office shall establish by regulation standards and procedures for enrollment waivers.