§ 1 Definitions
§ 2 Application of laws
§ 3 Organization; accounting; contracts
§ 4 Required coverage for certain conditions and groups
§ 4A Employees terminated due to plant closings; coverage
§ 4AA Coverage for medically necessary acute treatment and clinical stabilization services
§ 4B Confidentiality of information; mental or nervous condition; exceptions
§ 4C Home care benefits
§ 4CC Coverage for medical or drug treatments to correct or repair disturbances of body composition caused by HIV associated lipodystrophy syndrome
§ 4D Nonprescription enteral formulas for home use
§ 4DD Filling of remaining portion of prescription for covered drug that is a narcotic substance earlier filled in lesser quantity
§ 4E Off-label drug use; cancer treatment
§ 4EE Pain management access plans
§ 4F Group health maintenance contracts; coverage for bone marrow transplants
§ 4FF Coverage for tobacco use cessation counseling and tobacco cessation products
§ 4G Off-label use of prescription drugs for HIV/AIDS treatment
§ 4GG Coverage for treatment of pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections and pediatric acute-onset neuropsychiatric syndrome
§ 4H Items medically necessary for diagnosis and treatment of diabetes
§ 4I Abortion, abortion-related care, prenatal care, childbirth and postpartum care benefits; minimum coverage for in-patient care; exemptions
§ 4II Coverage for prescription eye drops
§ 4J Scalp hair prostheses necessary due to cancer or leukemia treatment
§ 4JJ Coverage for mental health or substance use disorder services delivered through psychiatric collaborative care model
§ 4K Newborn hearing screening tests
§ 4KK Coverage for medically necessary mental health acute treatment, community-based acute treatment and intensive community-based acute treatment
§ 4L Coverage for hospice services
§ 4LL Benefits for medically necessary emergency services programs
§ 4M Mental health benefits; biologically-based mental disorders; rape-related mental disorders; non-biologically-based mental disorders of children and adolescents under age 19
§ 4MM Coverage for annual mental health wellness examination
§ 4N Coverage for speech, hearing and language disorders; hearing aids
§ 4NN Coverage for federally-defined preventive services
§ 4O Outpatient services; hormone replacement therapy for peri and post menopausal women; contraceptive services; approved prescription contraceptive drugs or devices; exception
§ 4P Patient care services provided pursuant to qualified clinical trials
§ 4Q Coverage for human leukocyte or histocompatibility locus antigen testing
§ 4S Coverage for prosthetic devices and repairs
§ 4T Coverage for eligible dependents under 26 years of age or dependents mentally or physically incapable of earning their own living due to disability
§ 4U Coverage for medically necessary hypodermic syringes or needles
§ 4V Coverage for diagnosis and treatment of autism spectrum disorder
§ 4W Coverage for children under age 18 for cleft lip and cleft palate
§ 4X Coverage for orally administered anticancer medications
§ 4Y Coverage for abuse deterrent opioid drug products
§ 4Z Preauthorization for substance abuse treatment not to be required
§ 5 Emergency services provided to members for emergency medical conditions
§ 5A Divorced or separated spouses; coverage
§ 6 Contracts
§ 6A Group health maintenance contracts; contribution percentages
§ 6B Retroactive claims denials for behavioral health services
§ 8 Public dissemination of deceptive or misleading materials
§ 9 Trade regulation practices; application of law
§ 10 Reports; audits, examinations or inspections; confidentiality and privilege
§ 10A Applicability of chapter 176V to health maintenance organizations governed by this chapter
§ 10B Applicability of chapter 176W to health maintenance organizations governed by this chapter
§ 11 Contracts with group insurance commission or local governments
§ 11A Alternative dental coverage option
§ 12 Health regulations not limited
§ 13 Name restriction
§ 14 Licensure applicants; documents required; approval by commissioner
§ 15 Bond; waiver
§ 16 Contracts, rates, evidence of coverage; disapproval of commissioner
§ 16A Disapproval of certain health maintenance contracts based on high deductibles
§ 16B Disapproval of certain health maintenance contracts for coverage of young adults
§ 17 Rules and regulations; standardized claim form
§ 17A Open enrollment for nongroup medicare beneficiaries; period, notice of termination
§ 19 Discrimination against abuse victims in terms of health maintenance contract
§ 20 Insolvent health maintenance organization; administrative supervision, rehabilitation or liquidation; priority of claims
§ 20A Administrative supervision, rehabilitation or liquidation of health maintenance organizations; revocation or suspension of license
§ 21 Participating provider; contracts with health maintenance organizations; hold harmless clause; limitation on collection actions
§ 22 Health care providers; liability of member of health maintenance organization; limitation on collection of amounts owed
§ 23 Insolvency of health maintenance organization; replacement coverage
§ 24 Health maintenance contracts; genetic tests; discrimination based on genetic information
§ 25 Net worth of health maintenance organization
§ 26 Deposit maintained with trustee acceptable to commissioner
§ 27 Merger or acquisition of control
§ 28 Registration with commissioner
§ 29 Violations of Secs. 27 to 29; application for order enjoining violations of Secs. 27 to 29; penalties
§ 30 Statement for individuals provided with creditable coverage; reporting
§ 31 Attribution of members to a primary care provider
§ 32 Disclosure of patient-level data and contracted prices of individual health care services by carriers to providers
§ 33 Coverage for health care services delivered via telehealth by a contracted health care provider

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Terms Used In Massachusetts General Laws > Chapter 176G - Health Maintenance Organizations

  • Affidavit: A written statement of facts confirmed by the oath of the party making it, before a notary or officer having authority to administer oaths.
  • Amendment: A proposal to alter the text of a pending bill or other measure by striking out some of it, by inserting new language, or both. Before an amendment becomes part of the measure, thelegislature must agree to it.
  • Appeal: A request made after a trial, asking another court (usually the court of appeals) to decide whether the trial was conducted properly. To make such a request is "to appeal" or "to take an appeal." One who appeals is called the appellant.
  • Assets: (1) The property comprising the estate of a deceased person, or (2) the property in a trust account.
  • Bankruptcy: Refers to statutes and judicial proceedings involving persons or businesses that cannot pay their debts and seek the assistance of the court in getting a fresh start. Under the protection of the bankruptcy court, debtors may discharge their debts, perhaps by paying a portion of each debt. Bankruptcy judges preside over these proceedings.
  • Civil forfeiture: The loss of ownership of property used to conduct illegal activity.
  • Contract: A legal written agreement that becomes binding when signed.
  • Conviction: A judgement of guilt against a criminal defendant.
  • Corporation: A legal entity owned by the holders of shares of stock that have been issued, and that can own, receive, and transfer property, and carry on business in its own name.
  • Damages: Money paid by defendants to successful plaintiffs in civil cases to compensate the plaintiffs for their injuries.
  • Dependent: A person dependent for support upon another.
  • Discovery: Lawyers' examination, before trial, of facts and documents in possession of the opponents to help the lawyers prepare for trial.
  • Donor: The person who makes a gift.
  • Equitable: Pertaining to civil suits in "equity" rather than in "law." In English legal history, the courts of "law" could order the payment of damages and could afford no other remedy. See damages. A separate court of "equity" could order someone to do something or to cease to do something. See, e.g., injunction. In American jurisprudence, the federal courts have both legal and equitable power, but the distinction is still an important one. For example, a trial by jury is normally available in "law" cases but not in "equity" cases. Source: U.S. Courts
  • Evidence: Information presented in testimony or in documents that is used to persuade the fact finder (judge or jury) to decide the case for one side or the other.
  • Fair market value: The price at which an asset would change hands in a transaction between a willing, informed buyer and a willing, informed seller.
  • Fiscal year: The fiscal year is the accounting period for the government. For the federal government, this begins on October 1 and ends on September 30. The fiscal year is designated by the calendar year in which it ends; for example, fiscal year 2006 begins on October 1, 2005 and ends on September 30, 2006.
  • Fraud: Intentional deception resulting in injury to another.
  • Guardian: A person legally empowered and charged with the duty of taking care of and managing the property of another person who because of age, intellect, or health, is incapable of managing his (her) own affairs.
  • Interests: includes any form of membership in a domestic or foreign nonprofit corporation. See Massachusetts General Laws ch. 156D sec. 11.01
  • Jurisdiction: (1) The legal authority of a court to hear and decide a case. Concurrent jurisdiction exists when two courts have simultaneous responsibility for the same case. (2) The geographic area over which the court has authority to decide cases.
  • Liabilities: The aggregate of all debts and other legal obligations of a particular person or legal entity.
  • Oath: A promise to tell the truth.
  • Obligation: An order placed, contract awarded, service received, or similar transaction during a given period that will require payments during the same or a future period.
  • Other entity: includes a domestic or foreign nonprofit corporation. See Massachusetts General Laws ch. 156D sec. 11.01
  • Partnership: A voluntary contract between two or more persons to pool some or all of their assets into a business, with the agreement that there will be a proportional sharing of profits and losses.
  • Quorum: The number of legislators that must be present to do business.
  • Recourse: An arrangement in which a bank retains, in form or in substance, any credit risk directly or indirectly associated with an asset it has sold (in accordance with generally accepted accounting principles) that exceeds a pro rata share of the bank's claim on the asset. If a bank has no claim on an asset it has sold, then the retention of any credit risk is recourse. Source: FDIC
  • Sequester: To separate. Sometimes juries are sequestered from outside influences during their deliberations.
  • Settlement: Parties to a lawsuit resolve their difference without having a trial. Settlements often involve the payment of compensation by one party in satisfaction of the other party's claims.
  • Statute: A law passed by a legislature.
  • Subpoena: A command to a witness to appear and give testimony.
  • Testify: Answer questions in court.
  • Trial: A hearing that takes place when the defendant pleads "not guilty" and witnesses are required to come to court to give evidence.
  • Trustee: A person or institution holding and administering property in trust.
  • Writ: A formal written command, issued from the court, requiring the performance of a specific act.