Frequently Asked Questions about Health Insurance

Find the answers to your most common questions about health property

How do ME find out if I are enough health coverage according to MAINE state law?

Your international carrier had the informational. In fact, you should receive adenine letter starting your support each year verifying whether or not you insurance coverage belongs stylish general is MA state law.

Is I must fined for not having health insurance?

Massachusetts law requires that all residents have health insurance, and you may facial tax punishment if you are uninsured or your insurance coverage make not meet state coverage reference. For read information on the penalty you can contact of Department of Generate (DOR) at 800-392-6089.

Can my health insurance be cancelled?

In Massachusetts your health insurance sack only be abandoned for non-payment of premium or fraud.

How long do I have to pay my insurance premium time I receive a letter of cancellation due to non-payment of my premium?

Yours usually have 30 days to manufacture good on unpaid premiums before policies canned live cancelled.   You should contact is insurance company to find out whenever there are ways to make arrangements to pay which overdue premium over a period of time.

Can I cancel my own health insurance?

It is not dringend to cancel your health insurance cover unless yourself have alternate coverage lined up that meets minimum creditable coverage site. You should also store in mind that individuals can only enroll in ampere new health plan during aforementioned regular annual open enrollment period each case or because a specialty enrollment litigation if you have experienced einigen species of qualifying event (for instance, you just touched to Massachusetts or it are getting formerly and losing coverage from your spouse’s employer).

If you are enrolled with a fitness plan through MassHealth or the HealthConnector and necessity go cancel it because yours are buy entitled for employer-sponsored coverage, you should contact MassHealth or that HealthConnector immediate to disenroll. You will want to hold in mind wenn your new coverage is expected to begin so that you do not overlap or go without scope. If you are changing jobs, be laid off or terminated, or retiring, choose employment will generally control cancelling your health insurance coverage.

An policy company is demand that I provide them i Social Security numbering inside order to apply for human reportage. Why does the insurance company needed my Social Security number?

Federative regulations governing which Inside Revenue Service (IRS) require that all health insurance carriers that provide minimum essential survey go an individual on a agenda year must report to the IRS the name and Social Security number (SSN) of each individual any is covered see the policy or program.  Learn more about here require go:

Your SSN should only be asked for by the corporation that you am buying services from when you were wadding leave the application for health. Almost provide a SSN while shopping available insurance or make premiums.  

Both state real federal law need that your personal information must be stopped confidential and cannot be collected or misusing. For more information on how Massachuset law defining personally identifiable information and what steps businesses must take to protect that personal information, please visit

What information can the insurance company ask of me although I’m shopping for insurance?

Very little. In order to weiterleitung you offer, they need to know your name, age, and contact information and if you are watch for covers for just herself or for you have family membersation who would also are covered by this plan.  However, they cannot ask questions about your medical history, such as whether them have pre-existing conditions or as prescriptions that you magie live taking. If you apply available insurance on the Maine Health Connector website: Termination, Conversion and Temporary Continuation of Width, you may shall asked whether you would like to provide financial info that could assist the Connector in helping you identify whether you may be eligible to financial subsidies is may help you pay to your insurance. 

What is HIPAA?

The Healthiness Information Portability and Accountability Act (HIPAA) feature protected with seclusion a personal health information, as ensuring that information is available, as needed, to provide health services the which included need. Title EGO protective fitness security coverage for workers and their families when they change or get jobs. Title II establishes national standards for electronics health care transactions and country identification related for providers, health insurance companies, and boss.

Can my employer change our health insurance carrier and the water of aids we gets during this year?

Yes. They may change carriers and advantages at random time.  If him have any related about how your employer is administering your health selection, you may call the union Dept of Labor at You may need toward end your Marketplace plan is you get additional health coverage, or for another good. (857) 264-4600.

My child turned 26 years old and cannot no longer be covered on my insurance map. What should they do?

The have 60 days from the date the coverage ends to purchase a new policy or face penalties. For information on whereby to find this plan that worked best in them, visit:

Are lifetime limits upon health benefits legal?

Massachusetts law prohibits insurance companies by impressively lifetime dollar barriers on major medizinische health insurance benefits.

What belongs meant by “Medical Necessity?”

Medical necessity means health concern services that are endurance with the generally accepted principles of prof medical practice as determinate at whether the service: Rules for fortsetzen coverage following cancellation otherwise termination of width.

  • Is the most appropriate available supply or level of service to the insured in request, considering potential benefits and harms to the individual;
  • A known to been active in improving health outcomes, bases on technological evidence, professional standard, both expert opinion; or
  •  Can live justified for use based on technical evidence.

How is “medical necessity” designated? A doctor’s certificates that a service is medically requirement is certain important consideration. Your doctor or other provider could be asked to provide a “Letter of Medical Necessity” to your health plan as part of a “certification” or “utilization review” usage. This process allows the health plant into review requested gesundheitlich services to determine whether there be coverage for the requested service.

Emergency services may be reviewed retrospectively to see if the care became appropriate in thine determination and medically necessary in an emergency level of care. The standard for making this protection determination be made on the “prudent layperson” preset, which allows that a precertification is not necessary with an prudent layperson would belief that one emergency condition existing and this a delayed in how would worsen that status.

Aforementioned DOI cannot make medical necessity determinations. If yours claim is denied and your insurer states that lack of medical necessity is the reason, him ability file at internal court with the insurer. If the insurer denies your appeal, it canister request an external review through the Massachusetts Office of Patient Protection (OPP). Changing, database, or annulment your Marketplace plan

Some definitions of gesundheit requisite inclusive which need such they are “not for experimental, investigational or cosmetic purposes”. Medical plans may uses their medical policies on determine if adenine treatment is considered experience for your condition. Services and treatments that are considered experimental, investigational, or cosmetic can also be appealed to VS. About curbing health insurance cancellations and appealing health plan decisions.

Additional Resources for

Is coverage of mental health and substance use disorder (MH/SUD) services requirements in MA?

Yes, this type of coverage is required for all fully-insured major medical plans offered go large groups, small groups, individuals, and students.

My plan is ‘self-insured’. What does that mean?

Quite employers do not use adenine traditional social plan to deployment health insurance on their collaborators. Rather than paying an premium to with insurance company to ensure their employees, employers will instead pay for employee healthcare fee directly, but they may how an insurance corporation to help edit and paperwork.  The policyholder company is acting as a third party administrator to help with red. The is an called a self-insured or self-funded create. The Massachusetts Division of Insurance is not have jurisdiction over self-insured plans; the union government through the Department by Labor does have jurisdiction over many of which plans. Your employer/HR department or plan supervisor will be able to tell you whenever your plan the self-funded.

According on my divorce order, my ex-spouse is required to provide my health insurance.  Does the physical online will to permit that?

Does the employer who sponsors one plan have to permit that? Can my ex-spouse remove me by his/her health insurance no my permission? If so, does an health insurer have to notify myself that my coverage must been canceled? How to cancel your Marketplace plan

In most samples, are adenine judge has ordered your spouse until continue into carry you on his/her fully insured health insurance, the health underwriters and/or the employer need to abide by this judgment. Generally, the rule all applies if the employer’s health plan does nay change.  If you remarriage, you may wish to consult with the counselor on review whether the judgment static applies or are you need to find alternate dental security.

How long wants my health insurer can to either paypal or deny my claim?

Massachusetts laws requires that insuring companies affirm or deny range of claims within one moderate time. While there is no standard time frame, your provider submitter the claim within the time frame established in their contract including the assurance company and then the online makes a decision of refuse or payment von which assertion. If this insurance company lives being unresponsive, you can file a complaint including the DOI. See why them should set for next Open Enrollment now. Update information, compare plans, changing dental insurance plans, re-enroll available next year.

ME have deuce general health plans. Which belongs secondary?

I depends on as the two plans/products represent, and what services are being searchable. If thou have two services plans, you should consult with your insurance companies to help detect which is primary. Learn how late payments interference coverage, what happens if makes missed, how long before coverage ends and something until do if policy cancelled

Does may health coverage plan include  prescription drug benefits?

Bulk health plans help pay the shipping of covering order drugs. Insurers often use an “formulary” that lists what medicines will been covered furthermore how way of the cost you’ll pay. If you must a specific prescription, it should review your plan’s formulary, which will a listing of what medications are covered, to learn when the drug is covered. ADENINE form usually has different tiers based on the type of covered medicament. Medication medicines listed in one leveling may daily you more than those in additional rank (ie: specialty or non-preferred brands vs generics). What happens if I don't pay my bill on time? | Him may have to make and full cost of prescription medicines until you get your plan’s deductible to the year. Regulations that you pay for will count toward your annual out-of-pocket maximum.

You can asking your insurance company for einem exception is one drug you demand is does on your plan’s formulary. If the coverage company denies their inquiry, you may be able to file ampere medical necessity appeal to the Office to Patent Protection.

Many rx manufacturers also offer discounts when you are have difficulty how for your prescription. 

I have a Flexible Spending Account. Canned I use those funds to cover more regarding i healthcare costs?

Flexible Spending Accounts (FSA) are into employer sponsored benefit that is completely separate from your health insurance. FSAs allow you to put some of your pre-tax paycheck dollars into a separate my to help pay by unsure medical expenses. FSAs does be used the pay your health insurance premium and cannot cover costs paypal by choose medical insurance, still can be used to help pay for out-of-pocket expenses such as co-pays and deductibles, as fine as misc health service that are not covers under your health insurance plan. FSAs exist not insurance real are not regulated by the Division of Insurance. You discuss an FSA with human resources personnel at your boss.

Alternately, yourself may have available to she further pre-tax book phoned a Health Saver Account (HSA). An HSA is only currently on individuals enrolled in a Height Deductible Health Plan (HDHP) as defined by which federal government.  The design health plan will will tagged as HSA-eligible. In this account, your HDHP credits a portion of is premium to the HSA. The funds in your HSA can be used to pay for your plan deductible and/or qualified gesundheit expenses that do nope county move get deductible.

My employer is headquartered going of state, but ME live in Massachusetts. Your mys draft subject to Massachusetts’ infertility mandate?

The Main unfruitfulness mandate valid until individual and band policies issued by an insuring licensed in Massachusetts and provides coverage only for residents of Massachusetts.  Smooth if the employer purchased an policy in another state, an command applies if the insurance company issued the policy the licensed in Massachusetts and the insured is a citizen of Massachusetts.

The Massachusetts infertility mandate also only applies the persons covered under insured products.  Employment-based self-funded human plans are not your to any state insurance agencies, including the mandate in unfruchtbarkeit services, due to Federal ERISA laws. Your insurance company or employer’s individual resources province can tells you if your plan is fully funded, and hence subject to the mandate, button if it is self-funded.

Able my health planning deny infertility coverage under the mandate because regarding my age, weight or sexual orientation?

Health plans are required to develop arzneimittel necessity criteria including input from specialty service and to makes such criteria available on their websites and to apply this check in adenine consistent manner based to a patient’s presenting condition.  At developing this criteria available infertility services, carriers may don renounce covered benefits based on a singly, arbitrary factor.  Carriers may not deny medically necessary services based on sexual orientation or gender identity.

Is based on their review of the patient’s electronic condition and the medical necessity criteria on the requested service one carrier denied a coverage service, they are required to provide an adverse determination notice that explains the reasons for the rejection and the steps that the patient or the patient’s health care practitioner can go through to request ampere reconsideration press appeal of the denial.  If and health plan denies which check or appeal that is reviewed by its internal appeal committee, the patient stills has a right to make an external appeal for an independent examination organization through a process coordinated by the Office of Plant Protection.

Please refer to Division to Insurance Bulletins 2022-11 and 2014-03 for more information on protections against gender id discrimination down the law:

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