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General Laws

Section 2. The following words and phrases as used in this chapter shall have the following meanings:—

(a) “Commission”, the group insurance commission.

(b) “Employee”, any person in the service of the commonwealth, which shall include a person employed by the National Guard as a technician, and who is not at the same time an employee of the United States, and a person who is an employee of a mosquito control project, the Massachusetts Parking Authority, the metropolitan area planning council, the Montachusett regional planning commission, the central Massachusetts regional planning district commission, the Massachusetts State College Building Authority, Massachusetts School Building Authority, the commonwealth health insurance connector authority, the Massachusetts gaming commission, the Massachusetts Life Sciences Center, the Massachusetts Department of Transportation, the Massachusetts Bay Transportation Authority, Worcester county, the county cooperative extension service of Suffolk county, a local housing authority or a redevelopment authority, whether such person be employed, appointed or elected by popular vote, provided the duties of such person require that his time be devoted to the service of the commonwealth during the regular work week of permanent employees, except that persons elected by popular vote, other than those serving as members of mosquito control projects, local housing and redevelopment authorities, will be considered employees during the entire term for which they are elected regardless of the hours devoted to the service of the commonwealth. By way of illustration but not limitation, a person appointed or elected by popular vote shall include employees of the general court, state officials, constitutional officers and members of the general court, but shall in no event be construed to include members of the judiciary paid in whole or in part from other than state funds, seasonal employees or emergency employees. A determination by the commission that a person is eligible for participation in the plan of insurance shall be final and shall be binding on all parties. A person serving on a temporary or provisional basis in a position which is subject to the provisions of chapter thirty-one, notwithstanding the provisions of said chapter, and only for purposes of continuation of insurance coverages granted herein, may be granted a leave of absence by the appointing authority for reasons of illness of such person provided that the person agrees in writing to return to an active working status at the conclusion of such leave of absence in the same or similar position. Any such illness shall be evidenced by a certificate as prescribed by the commission of a registered physician approved by the commission. The appointing authority may extend such leave of absence from month to month subject to concurrence by the commission as to the continuation of the person’s insurance coverages. Such a leave of absence in the case of employment subject to said chapter thirty-one shall not be deemed to confer on the person any civil service rights which the person did not hold when said leave of absence was granted; and no person whose name is on an eligible civil service list for said position shall lose any rights to appointment to said position. A person employed by a regional council of government established pursuant to section 20 of chapter 34B or a regional planning district or commission established pursuant to chapter 40B, a non-unionized education collaborative as defined by section 4E of chapter 40 or a commonwealth charter school as defined by section 89 of chapter 71 shall be an employee under chapter 32A and subject to the terms and conditions of said chapter 32A including, but not limited to, premium contribution ratios, in the event that the governing body of the regional council of government or the regional planning district or commission votes to accept that status and notifies the commission of the vote.

(c) “Employer”, the commonwealth of Massachusetts.

(d) “Dependents”, an employee’s spouse, his unmarried children under 26 years of age or for 2 years after the end of the calendar year in which such persons last qualified as dependents under 26 U.S.C. 106, whichever occurs first, and any child nineteen years of age or over who is mentally or physically incapable of earning his own living, provided that an additional premium is paid for the coverage of such handicapped child. Said definition shall also include an unmarried child, nineteen years of age or over, who is a full-time student in an educational or vocational institution and whose program of education has not been substantially interrupted by full-time employment, excluding service in the armed forces. The standards for such full-time instruction and the time required to complete such program of education shall be determined by the commission. Contributions toward the total monthly premium or rate applicable to the health insurance coverage for a full-time student shall be as provided for in section eight, but such contribution shall cease upon the student’s attainment of age twenty-four or the following June thirtieth of the year in which the student attains said age; however, at the option of the employee, such coverage may be continued beyond said age or date provided that the total monthly premium or rate is paid in full by the employee and the method of payment by the active or retired employee shall be as determined by the commission. Said definition shall further include the parents of an employee, or an employee who retired on or after January first, nineteen hundred and fifty-six, who are dependent upon him for over one half of their annual maintenance and support, proof of which shall be furnished to the satisfaction of the commission upon its request. The commission shall establish a separate schedule of hospital, surgical, medical, dental and other health insurance benefits for dependent parents, and the claim experience applicable thereto shall be maintained separately from the schedule of hospital, surgical, medical, dental and other health insurance benefits and claim experience applicable to employees insured hereunder. Payment of the premium applicable to the schedule of hospital, surgical, medical, dental and other health insurance benefits for dependent parents shall be made to the commission without contribution by the commonwealth. Any person who fraudulently claims to furnish over one half of the maintenance and support of a dependent parent which claim results in the parent becoming insured hereunder, shall, upon the determination by the commission, forfeit his eligibility for insurance coverage under this chapter for a period of not less than one or more than three years from the date of such determination.

(e) A person is deemed to work a regular work week of permanent employment when he meets the applicable requirements of section five of chapter eight, sections thirty and thirty A of chapter one hundred and forty-nine, or any general or special law pertaining to a regular work week of permanent employment; or whose duties require no less than eighteen and three-quarters hours, regularly, in the service of the commonwealth during the regular work week in a position for which the established regular work week is thirty-seven and one-half hours; or whose duties require no less than twenty hours, regularly, in the service of the commonwealth during a regular work week in a position for which the established regular work week is forty hours. In the event that a department head is unable to apply the terms defined above to a specific set of circumstances all facts relative thereto shall be submitted to the commission for a determination of eligibility and such determination shall be final.

(f) “Elderly governmental retirees”, employees of the commonwealth, housing and redevelopment authorities, mosquito control projects and technicians of the National Guard retired prior to the effective date of contracts or agreements issued under this chapter who are receiving a pension or retirement allowance from the commonwealth sufficient from which a monthly insurance premium may be withheld; and employees of counties, cities, towns and districts including “teachers” as defined in section one of chapter thirty-two, retired prior to the effective date of contracts or agreements issued under the provisions of chapter thirty-two B as, or when, adopted by the political subdivision from which they are retired, and who are receiving a pension, annuity or retirement allowance sufficient from which a monthly insurance premium may be withheld.

(g) “Optional medicare extension”, a program of hospital, surgical, medical, dental and other health insurance for such active and retired employees of the commonwealth and their dependents, and such active and retired employees of certain counties, cities, towns and districts and their dependents as are eligible or insured under the federal health insurance for the aged act as may be amended from time to time.

(h) “Health care organization”, an organization, including without limitation a health maintenance organization for the group practice of medicine, with or without hospital or other medical institutional affiliations, which furnishes to the patient a specified or unlimited range of medical, surgical, hospital and other types of health care services.

(h1/2) “Primary care provider”, a health care professional qualified to provide general medical care for common health care problems who; (1) supervises, coordinates, prescribes, or otherwise provides or proposes health care services; (2) initiates referrals for specialist care; and (3) maintains continuity of care within the scope of practice.

(i) “Wellness program”, a program designed to measure and improve individual health by identifying risk factors, principally through diagnostic testing and establishing plans to meet specific health goals which include appropriate preventive measures. Risk factors may include but shall not be limited to demographics, family history, behaviors and measured biometrics.

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