Minimial Creditble Coverage/MCC information for Businesses (updated on 12/30/08)

It is important to be aware that starting on January 1, 2009, Massachusetts residents 18 years of age or older, who are NOT exempt from the Individual Mandate, will have to have health insurance that is deemed affordable to them at their income level AND meets "Minimal Creditable Coverage" (MCC) standards set by the Connector. It is very important to note that the Minimal Creditable Coverage requirement is being phased in. So for 2007 and 2008, one will only have had to prove they have insurance and the insurance does not have to meet MCC standards for those years. There are also exceptions for the MCC requirement- i.e. some people may be exempt from having to have insurance that meets MCC standards in 2009 and beyond.

No employer has to offer MCC compliant health plans to their employees. The burden is on an individual to make sure their health care plan meets MCC standards, not the business that employs them. In anycase, get it IN WRITING from your health care insurance carrier that your health plan is or is not MCC compliant.

It is important to note that open enrollment periods for many health plans occur in 2008- the period of coverage will go through portions of 2009 (i.e. there is a one year contract for coverage). Therefore in 2008, many people will have had to pick health plans that are MCC compliant to avoid being penalized on their 2009 Massachusetts State Taxes.

Key health plans a business may offer their employees that already meet MCC standards:

*A health arrangement provided by established religious organizations comprised of individuals with sincerely held beliefs qualifies for MCC standard.

*Any high deductible health plan ("HDHP") that complies with federal statutory and regulatory requirements for Health Savings Accounts (HSA) are considered MCC compliant (Note in 2010-there will some limits on HDHP/HSA-they will have to provide a broad range of medical services and Pre-deductible preventive care benefits- HDHP/HSA plans that do not offer the specificis of MCC will need a determination from the Health Connector -this will need to be done if you are renewing on Feb 1, 2009 or later!).

*All the Commonwealth Choice Plans are considered MCC compliant.

*Safe Harbors for Collectively-bargained plans "in force on 1/1/09 may be deemed MCC compliant for up to 1 year beyond an expired collective bargaining agreement.

*Safe Harbors - The Health Connector can approve plans that cover a broad range of medical benefits if the relative value of the benefits are comparable to the value of a Health Connector Bronze plan. For information on how to get plans approved under the safe harbor see the Connector's webpage on MCC's requirements and see its MCC certification form.


So what do MCC complient plans have to have? Also see the Connector's webpage on MCC's requirements. (We recommend you print that page out)


"*Primary and preventive care

*Emergency services

*Hospitalization benefits

*Diagnostic surgery

*Prescription drug coverage. Any separate prescription drug coverage deductible may not exceed $250 for an individual and $500 for a family

*Ambulatory patient services

*Mental health services

*No annual or per-sickness benefit maximum

*No per diem limit on in-patent care

*Annual deductibles capped at $2,000 for individual and $4,000 for family coverage

*Annual out-of-pocket spending capped at $5,000 for an individual and $10,000 for a family receiving in-network services, if the plan includes a deductible or co-insurance on core medical services

*Any out-of-pocket maximum must include the upfront deductible, most coinsurance and any service that requires a co-payment of $100 or more

*A minimum of three visits to the doctor for an individual and six for a family prior to any upfront deductible"

QUOTED FROM the Connector's Dec 10, 2007 press release "HEALTH PLANS OFFERED IN 2008 SHOULD MEET NEW STANDARDS"

*Other ways of Meeting MCC- You meet MCC if you are enrolled in: * Medicare Part A or B; * Any Commonwealth Care plan; * Any Commonwealth Choice plan (including Young Adult Plans); * MassHealth (except MassHealth Limited); * A federally-qualified high deductible health plan (HDHP); * A Student Health Insurance Plan (SHIP); * A tribal or Indian Health Service plan; * TRICARE; * The U.S. Veterans Administration Health System; or * Peace Corps, VISTA or AmeriCorps or National Civilian Community Corps coverage... Also, the Health Connector may deem collectively-bargained plans that are in force on Jan. 1 2009 compliant with MCC for up to one year after a collectively-bargained agreement has expired. Individuals may be exempt from the tax penalty if they can validate that they have a firmly held religious belief that prevents them from enrolling in a health insurance plan.