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December 04, 2025 Clouds | 19°F
The 194th General Court of the Commonwealth of Massachusetts
  1. General Laws
  2. Part I ADMINISTRATION OF THE GOVERNMENT
  3. Title XXII CORPORATIONS
  4. Chapter 176G HEALTH MAINTENANCE ORGANIZATIONS
  5. Section 16 Contracts, rates, evidence of coverage; disapproval of commissioner

Section 16

Section 16: Contracts, rates, evidence of coverage; disapproval of commissioner

[ First paragraph effective until April 8, 2025. For text effective April 8, 2025, see below.]

  Section 16. The subscriber contracts, rates and evidence of coverage shall be subject to the disapproval of the commissioner. No such contracts shall be approved if the benefits provided therein are unreasonable in relation to the rate charged, nor if the rates are excessive, inadequate or unfairly discriminatory. Classifications shall be fair and reasonable.

[ First paragraph as amended by 2024, 343, Sec. 77 effective April 8, 2025. For text effective until April 8, 2025, see above.]

  The subscriber contracts, rates and evidence of coverage shall be subject to the disapproval of the commissioner. No such contracts shall be approved if the benefits provided therein are unreasonable in relation to the rate charged, nor if the rates are excessive, inadequate or unfairly discriminatory. For the purposes of the review of rates of payment under this section, whether a contract is not excessive shall include considerations of affordability for consumers and purchasers of health insurance products; provided, however, that such review shall adhere to principles of solvency and actuarial soundness. Classifications shall be fair and reasonable.

  To the extent that this chapter is inconsistent with the provisions of chapter one hundred and seventy-six K, and any regulations promulgated thereunder, medicare supplement insurance plans as defined in said chapter one hundred and seventy-six K shall be subject to the provisions of said chapter one hundred and seventy-six K.

  To the extent that this section is inconsistent with the provisions of chapter one hundred and seventy-six M and any regulations promulgated thereunder, any nongroup health maintenance contract that is within the definition of a guaranteed issue health plan in said chapter one hundred and seventy-six M shall be governed by the provisions of said chapter one hundred and seventy-six M and any regulations promulgated thereunder.