Amendment ID: H3452-4

Amendment 4

QHP Wrap Protections

Mr. Downing moves to amend the bill by striking out section 87 and inserting in place thereof the following section:-

“Section 87. Section 3 of said chapter 176Q is hereby amended by striking out clause (b) and inserting in place thereof the following clause:-

(b) to determine each applicant’s eligibility for purchasing insurance offered by the connector, and to establish eligibility criteria and determine eligibility for premium assistance payments and point of service cost-sharing subsidies for applicants at or below 300 per cent of the federal poverty guidelines who are not eligible for any basic health program established pursuant to section 9 of chapter 118E, subject to the following conditions: (1) for individuals with household income that does not exceed 100 percent of the federal poverty level, offer health insurance plans that include the medically necessary dental services available to adult MassHealth members, and said individuals shall not be responsible for premium contributions and shall be responsible for no higher cost-sharing than cost-sharing required of enrollees in the MassHealth program at the same income level; (2) for individuals not described in clause (1) with household income that does not exceed 150 per cent of the federal poverty level, at least one plan with no required premium contribution, (3) for  individuals not described in clauses (1) or (2) with household income that does not exceed 300 per cent of the federal poverty level, premium contributions that shall not exceed 5 per cent of household income, and (4) for all individuals with household income that does not exceed 300 per cent of the federal poverty level, the opportunity to obtain a temporary premium waiver due to substantial financial or medical hardship as determined by the connector based on standards developed by the board.”