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April 15, 2026 Clouds | 65°F
The 194th General Court of the Commonwealth of Massachusetts

Bill S.685 194th (Current)

An Act relative to transparency of consumer health insurance rights

By Ms. Creem, a petition (accompanied by bill, Senate, No. 685) of Cynthia Stone Creem for legislation relative to transparency of consumer health insurance rights. Financial Services.

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Bill Information

Presenter:
Cynthia Stone Creem
Status:
Referred to Senate Committee on Ways and Means
This bill would require health insurance plans that are regulated by the Commonwealth to include the following statement on plan members’ identification cards: “This health plan is fully-insured, subject to all Massachusetts insurance laws.” This simple requirement would make it much easier for patients—and their providers and their advocates—to understand what rights they have and what treatments are covered under their health plans. At least 12 states have already created a similar disclosure requirement, including our neighbors in Connecticut and New York. Roughly half of Massachusetts residents with employer-based health insurance are in “fully-insured” plans regulated under Massachusetts law, while the other half are in “self-funded” plans that are federally regulated. The distinction is important, because fully-insured plans are subject to state mandates guaranteeing access to treatment for more than a dozen medical conditions and for mental health conditions generally, and self-funded plans are not subject to these mandates. Massachusetts law also provides patients in fully-insured plans with stronger procedural protections relating to prior authorization and appeals. Thus, knowing whether your plan is fully-insured or self-funded means knowing what health care you are entitled to receive and how you can access it. Without required transparency, patients typically do not know which type of plan they have, and so those with fully-insured plans are unable to assert the rights that the Legislature has granted to them. Compounding the confusion, the Commonwealth’s major health insurance carriers administer both fully-insured and self-funded plans—and even in their benefit handbooks, they typically fail to disclose what type of plan a patient has.
* The bill summary was created by the Primary Sponsor of the bill; no committee of the General Court certifies the accuracy of its contents.

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