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The 192nd General Court of the Commonwealth of Massachusetts

Section 1: Definitions

  Section 1. The following words, as used in this chapter, unless the context otherwise requires or a different meaning is specifically prescribed, shall have the following meanings:

[ Definition of "Behavioral health services'' inserted preceding definition of "Commissioner'' by 2019, 41, Sec. 53 effective July 1, 2019. See 2019, 41, Sec. 111.]

  "Behavioral health services'', mental health and substance use disorder prevention, recovery and treatment services including, but not limited to, inpatient, 24-hour levels of care, 24-hour and non-24-hour diversionary levels of care, intermediate levels of care and outpatient services.

[ Definition of "Commissioner'' effective until July 1, 2019. For text effective July 1, 2019, see below.]

  "Commissioner'', the commissioner of insurance.

[ Definition of "Commissioner'' as amended by 2019, 41, Sec. 53 effective July 1, 2019. See 2019, 41, Sec. 111. For text effective until July 1, 2019, see above.]

  "Commissioner'', the commissioner of insurance.

  "Company'', all corporations, associations, partnerships or individuals engaged as principals in the business of insurance including reciprocal exchanges as defined (as "Exchange'', "Domestic Exchange'' or "Foreign Exchange'') in section ninety-four A.

  "Contract on a Variable Basis'', any life policy or contract, annuity contract or any other policy or contract which provides for benefits, values or payments in variable amounts in accordance with the provisions of section one hundred and thirty-two F or section one hundred and thirty-two G.

  "Domestic company'', a company incorporated or formed in the commonwealth.

  "Foreign company'', a company formed by authority of any state or government other than this commonwealth.

  "Industrial life insurance policy'' or "policy of industrial life insurance'', a policy of life insurance (a) the premiums on which are payable weekly, or (b) the premiums on which are payable monthly or oftener, but less often than weekly, and the face amount of insurance of which is less than one thousand dollars and on the face of which the words "industrial policy'' are plainly printed.

  "Insurance company'' or "insurer'', the same meaning as "company''.

  "NAIC'', the National Association of Insurance Commissioners or its successor organization.

  "Net assets'', the assets of a company, less the total liabilities of the company, both as shown on the latest statement of financial condition prepared in accordance with section 25.

  "Net value of policies'', the liability of a company upon its insurance contracts, other than accrued claims, computed by rules of valuation established by sections nine to twelve, inclusive.

  "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.

  "Profits'' of a mutual company, that portion of its cash funds not required for payment of losses and expenses nor set apart for any purpose allowed by law.

  "Receiver'', receiver, liquidator, or conservator as the context requires.

  "Resident'', with respect to any incorporator, officer or director of a company, a person who shall have resided within the commonwealth at least one year immediately prior to the election, or the exercise of the authority, referred to in the context.

[ Definition of "Retroactive claims denial' inserted following definition of "Resident'' by 2019, 41, Sec. 54 effective July 1, 2019. See 2019, 41, Sec. 111.]

  "Retroactive claims denial'', an action by an insurer, an entity with which the insurer subcontracts to manage behavioral health services or an entity with which the insurer has entered into an administrative services contract or a contract to manage behavioral health services to deny a previously paid claim for such services and to require repayment of the claim or to impose a reduction in other payments or otherwise withhold or affect future payments owed to a provider in order to recoup payment for the denied claim.

  "Statistical agent'', an entity with proven systems for protecting the confidentiality of individual insured and insurer information; demonstrated resources for, and history of, ongoing electronic communications and data transfer with its member or subscriber insurers, which ensure the integrity of the transferred data; and a history of aggregation of data and accurate promulgation of the experience modifications in a timely fashion.

  "Unearned premiums'', as defined in the National Association of Insurance Commissioners Accounting Practices and Procedures Manual, unless modified by the commissioner as the commissioner considers appropriate.