Mass. Gen. Laws ch. 176G § 3

Current through Chapters 1 to 249 and Chapters 253 to 255 of the 2024 Legislative Session

Section 176G:3 - Health maintenance organizations; organization; accounting; contracts

A carrier or any two or more such companies, corporations, or their subsidiaries or affiliates may:

(1) organize and operate a health maintenance organization as a line of business, division, department, subsidiary or affiliate under the provisions of this chapter provided that where such is organized as a line of business, division, department, subsidiary or affiliate, the operation of the health maintenance organization shall be separately accounted for, the income and expenses shall be allocated in accordance with statutory accounting practices and procedures prescribed or permitted by the commissioner, and the carrier or companies shall not utilize the income from such health maintenance organization for unrelated activities.

(2) contract with a health maintenance organization to provide insurance, reinsurance, health services, reimbursement for health services or similar protection against the cost of care provided through the health maintenance organization;

(3) contract with a health maintenance organization to provide coverage, health services or reimbursement for health services in the event of the failure of the health maintenance organization to meet its obligations under health maintenance contracts issued by it or a carrier;

(4) contract with a health maintenance organization to provide administrative, underwriting, financing or other services relating to the provision of hospital, medical or other health services or reimbursement therefor;

(5) contract with a health maintenance organization to enroll members on behalf of the health maintenance organization or to issue its own certificate of benefits for the covered health services provided by the health maintenance organization; and,

(6) contract with a health maintenance organization for the joint administration of their business or for the writing and issue by the health maintenance organization, the carrier, or both jointly, of health maintenance contracts binding upon the carrier.

Mass. Gen. Laws ch. 176G, § 3

Amended by Acts 2003, c. 141, § 40, eff. 1/1/2004.